Mr Cheng Hean Lo1, Dr Elaine Chong2, Dr Shiva Akbarzadeh1, Professor Wendy Brown3, Ms Heather Cleland1
1Victorian Adult Burns Service, Melbourne, Australia, 2Centre for Eye Research Australia, Royal Victorian Eye & Ear Hospital, East Melbourne, Australia, 3Monash University, Melbourne, Australia
Several issues persist in clinical translation and application of cultured epithelial autografts during treatment of patients with massive burn injuries. The aim of this systematic review is to determine (1) current practice and trends in clinical application and (2) clinical efficacy of cultured epithelial autografts.
A structured literature search was performed in Ovid MEDLINE from 1946 and Ovid EMBASE from 1974 till present. All published peer-reviewed randomized or non-randomised clinical studies, cohort studies, prospective or retrospective series involving human application of cultured epithelial autografts in the setting of burn injury were included.
From 7267 studies initially identified, 77 studies were included in the analysis. Ninety-six percent (74/77) of these series had a sample size of less than 100 patients. In 76.6% (59/77) publications, average burn treated exceeded 40% total body surface area. Overall, cultured epithelial autograft take rates reported in the literature were inconsistent and varied significantly from 0-100%. There was a recent trend for co-application of cultured grafts with autologous skin grafts, achieving relatively high and consistent take rates of 73-96%. Results from cultured epithelial autograft application remained unpredictable.
This technology remains an adjunct or biological dressing, and not an alternative to conventional split skin graft. However, it has contributed to wound closure and it has been life saving in selected circumstances. Skin tissue engineering should continue as the clinical need for skin replacement is foreseeable into the future.
He is a specialist plastic & reconstructive surgeon from the Victorian Adult Burns Service at The Alfred, Victoria. He has published more than thirty peer-reviewed journal articles and presented at national and international meetings. He is a senior adjunct lecturer at Monash University and continues to be actively engaged in research.