[Use of keratinocyte cultures in treatment of severe burns--experiences up to now, outlook for further subsequent developments].

There is a world-wide growing interest in cultured epithelium. It is commonly accepted that cultured epithelial auto- or allografts can stimulate wound healing and shorten re-epithelialization time. Sheets of cultured autologous epidermal cells have been used for more than 15 years as grafts to achieve permanent coverage of full-thickness burn wounds. Yet many surgeons who have used cultured epidermal grafts have reported a substantial variability in their outcome. The best results have been obtained by performing early excision, followed by temporary coverage with a cadaver homograft. Within 3 weeks the donor allodermis is incorporated and forms a neodermis. The epidermal parts of the donor skin are removed after about 3 weeks and cultured epidermal autografts are transplanted (composite graft technique). There is some hope that progress in the cultivation procedure and a modified transplantation technique will shorten the healing time. In our opinion, great progress was made when cryopreserved allogeneic epithelial grafts became available for the treatment of deep dermal burn wounds. We obtained a good re-epithelialization rate (56%) after 9.5 days in 56 cases. In the last 25 cases, the re-epithelialization time was 72% after 11.5 days. Especially burn wounds of the face have been treated successfully, avoiding over-grafting and achieving highly acceptable, aesthetic and functional results. Many laboratories are developing dermal equivalents, combining synthetic and biological materials in order to form a multilayer neodermis. Although it seems possible to cultivate adnexae of the skin, a neodermis with cultivated adnexae is not yet in sight.