Autologous cultured epithelium on the allogeneic dermis for massive burns

In 1986, Cuono et al first reported the use of autologous (auto) cultured epithelium (CE) on the allogeneic (allo) dermis for the repair of skin burns. First, the escharectomized burn is resurfaced with human skin allograft. Subsequently, the epidermis is removed and replaced with auto CE. In 1990, we applied this technique in a 3-year-old boy who had sustained burns on 85% of his total body surface area and achieved an 80% 'take'. This suggests that the allo dermis provides an ideal substrate for the application of the auto CE. With the passing months and years, the auto CE on the allo dermis area became smoother and more supple, and at 4 years postoperatively, the appearance of the skin and its elasticity were evaluated, along with the status of hydration at the grafted sites. The skin elasticity was found to be more pliable and better than has been achieved with meshed skin grafts using a suction device. Also, hypertrophic scarring was less and, by electrical measurement technique using conductance to high frequency 3.5 MHz, the water content in the horny layer was greater than has been achieved with meshed skin grafts. These results indicate that the application of auto CE on the allo dermis is a reliable and useful method for massive burns, and that it subsequently provides acceptable cosmetics.