Autologous keratinocyte transplantation may help to overcome the drawbacks associated with existing options for skin coverage of large burns, according to a report in Plastic and Reconstructive Surgery—Global Open.

While split-thickness skin grafting remains the standard technique, with a success rate of nearly 95%, there is also a high rate of complications at the skin graft donor site.

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.

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 life-saving in severely burned patients, it has limitations—including long culture time and the need for special laboratory techniques.

Enter keratinocyte grafting.

In this technique, keratinocytes are isolated then transplanted in a “preconfluent” 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. Another plus: Transplanted cells proliferate and develop in the wound site during keratinocyte transplantation.

In the new report, study authors, led by Dr Jiad Noel Mcheik of CHU de Poitiers, France, reported encouraging results with keratinocyte transplantation using both allografts and autografts. In a preliminary study of boys with burn injuries, they achieved excellent results using keratinocytes isolated from the boys’ own foreskins.

Still, some important questions remain about autologous transplantation—including the optimal source, cell type, and transplantation technique; and the final outcomes, including new skin generation and scarring.