COMPARATIVE-ASSESSMENT OF CULTURED SKIN SUBSTITUTES AND NATIVE SKIN AUTOGRAFT FOR TREATMENT OF FULL-THICKNESS BURNS

Objective Comparison of cultured skin substitutes (CSSs) and split-thi ckness autograft (STAG) was performed to assess whether the requiremen t for autologous skin grafts may be reduced in the treatment of massiv e burns. Summary Background Data Cultured skin substitutes consisting of collagen-glycosaminoglycan substrates populated with autologous fib roblasts and keratinocytes have been demonstrated to close full-thickn ess skin wounds in athymic mice and to express normal skin antigens af ter closure of excised wounds in burn patients. Methods Data were coll ected from 17 patients between days 2 and 14 to determine incidence of exudate, incidence of regrafting, coloration, keratinization, and per centage of site covered by graft (n = 17). Outcome was evaluated on an ordinal scale (0 = worst; 10 = best) beginning at day 14, with primar y analyses at 28 days (n =10)and 1 year(n = 4) for erythema, pigmentat ion, epithelial blistering, surface roughness, skin suppleness, and ra ised scar. Results Sites treated with CSSs had increased incidence of exudate (p = 0.06) and decreased percentage of engraftment (p < 0.05) compared with STAG. Outcome parameters during the first year showed no differences in erythema, blistering, or suppleness. Pigmentation was greater, scar was less raised, but regrafting was more frequent in CSS sites than STAG. No differences in qualitative outcomes were found af ter 1 year, and antibodies to bovine collagen were not detected in pat ient sera. Conclusions These results suggest that outcome of engrafted CSSs is not different from STAG and that increased incidence of regra fting is related to decreased percentage of initial engraftment. Incre ased rates of engraftment of CSSs may lead to improved outcome for clo sure of burn wounds, allow greater availability of materials for graft ing, and reduce requirements for donor skin autograft.