A transplantation technique using the patient’s own skin cells—without the need for prolonged culture—may provide a new alternative for skin coverage in burn patients, suggests a report in Plastic and Reconstructive Surgery—Global Open®, the official open-access medical journal of the American Society of Plastic Surgeons (ASPS).
The technique, called autologous keratinocyte transplantation, may help to overcome the drawbacks of existing options for skin coverage of large burns, according to the article by Dr Jiad Noel Mcheik of CHU de Poitiers, France, and colleagues.
Alternatives for skin coverage of large burn wounds
Providing skin coverage for large burn wounds is a “tricky clinical problem” in plastic and reconstructive surgery, the authors write. In addition to physiologic abnormalities caused by major burns, there is often simply not enough normal skin available for grafting.
Split-thickness skin grafting remains the standard technique, with a success rate of nearly 95 percent. There is also a high rate of complications at the skin graft donor site, including pain and scarring.
For patients with large burns who don’t have adequate tissue for skin grafting, alternative techniques are available. These include a “mesh” technique to extend the size of the available graft and microskin grafting using tiny ‘diced’ pieces of skin graft can be used for patients with major burns.
Another option is the use of cultured epithelial autograft (CEA)—sheets of the patient’s own epithelial cells, grown in the laboratory. But while CEA is potentially lifesaving in severely burned patients, it has important limitations—including long culture time and the need for special laboratory techniques.
Keratinocyte grafting—A new alternative?
Against this backdrop, Dr Mcheik and colleagues believe that transplantation of keratinocytes—the most common type of cell in the outermost skin layer—is a ‘turning point in skin grafting.’ In this technique, keratinocytes are isolated then transplanted in a ‘pre-confluent’ state—before they form a sheet of skin, as in CEA.
By avoiding the need for skin cell culture, this technique allows the burned area to be covered within a few days, compared to the several weeks required for CEA. Keratinocyte transplantation also has other advantages related to the fact that the transplanted cells proliferate and develop in the wound site. Dr Mcheik and coauthors note recent experiments showing encouraging results with keratinocyte transplantation using both allografts (donated cells) and autografts (patient’s own cells). In a preliminary study of boys with burn injuries, they achieved excellent results using keratinocytes isolated from the boys’ own foreskins. That study highlights the importance of ‘choosing an optimal donor site containing cells with high proliferative capacity,’ according to the authors.
Dr Mcheik and colleagues note that some important questions remain to be answered about autologous transplantation—including the optimal source, cell type, and transplantation technique; and the final outcomes, including new skin generation and scarring. They conclude: ‘Successful clinical results and the easy management of the keratinocyte isolation procedure in the operating room allowed us to design the non-cultured autologous keratinocyte transplantation as a standard procedure, which can be added to the arsenal of therapies for burned patients in surgical units everywhere.’
