• Cheng Hean Lo, Shiva Akbarzadeh, Catriona McLean, Andrew Ives, Eldho Paul, Wendy A Brown, and Heather Cleland.
• Victorian Adult Burns Service, Ward 6 West, Main Ward Block, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; Department of Surgery, Monash University, 55 Commercial Rd, Melbourne, Victoria 3004, Australia. Electronic address: c.lo@alfred.org.au.
• J Plast Reconstr Aesthet Surg. 2019 Mar 1; 72 (3): 427-437.

Background/AimLast century, our laboratory produced Cultured Epithelial Autograft (CEA) for clinical use by the affiliated adult burn service and other burn units across the country. Production of CEA for clinical use was discontinued after several years because of a low success rate and subsequent low demand. Recently, at our burns unit, a cell culture program was reintroduced as a direct response to the need for improvement in ongoing deficiencies and clinical requirements in burn wound closure. The aim of this study was to validate the laboratory processes and clinical algorithms established and share our recent clinical experiences involving CEA.MethodsThis observational cohort study recruited patients with burns exceeding 35% TBSA admitted to the Victorian Adult Burns Service at The Alfred (December 2013-December 2016). Autologous keratinocytes were expanded and delivered through sheets of fibrin carrier.ResultsTwelve patients were recruited to participate in the study. Thirty-two sites were treated with CEA. CEA applied in combination with widely meshed SSG led to the highest take rate (90.1%) at 7-10 days. Further, debridement and grafting were necessary in sixteen of thirty-two sites treated, all involving wound beds prepared with Cuono method or sites treated with CEA only.ConclusionIt is important to address the problem of wound bed contamination, either through increased resistance on the part of the construct or wound bed sterilization. Improved understanding of the relative importance of vascularization, control of cell behavior, the extracellular matrix, immune function, and intrinsic antimicrobial capacity for graft take would then inform a more targeted approach to skin tissue engineering for wound closure in severe burns.Copyright © 2018 Elsevier Ltd. All rights reserved.

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