Burns research & reconstructive surgery

Cultured Epidermal Autograft (CEA)

While autologous skin grafting technique remains the standard method for burn wound management, the lack of available donor sites is always a major issue in treating patients with large and severe burn injuries.

Cultured epidermal autograft (CEA), well-established at the Skin Culture Laboratory at Concord Hospital, is a novel technique by which skin keratinocyte stem cells are isolated from a small skin biopsy taken from the patient. Under laboratory conditions it is cultivated into epidermis-like tissue more than 500 times the size of the biopsy area and transplanted back to the same patient. As an alternative resource of skin grafts, CEA grafts provide not only immediate coverage but also living cells and biological factors to facilitate wound healing and closure. The CEA technique shows great potential in treating severe burns because it requires only a small skin biopsy of about 4 cm2 therefore creating small donor-site wounds.

CEA technology has achieved some excellent results in burns and donor-site wound care. However, it shows limited clinical application. Unsatisfactory clinical results have been observed when CEA sheets alone are used for very deep burns involving dermal damage. CEA sheets need a regenerated dermal template in order to attach and then close the wound. CEA grafts fail in most deep wounds without dermal support. Even if they remain viable the quality of reconstructed skin is poor and fragile because of the lack of a good dermal bed to support and facilitate the growth and differentiation of epidermal cells.

Our laboratory The ANZAC Institute is committed to improving the cultured skin autograft technology by developing three-dimensional dermal substitutes and skin equivalents for treating deep burn wounds. Using technologies including tissue culture, cell biology, molecular biology and cellular and tissue engineering, we have been trying to produce different biological scaffolds that are biologically compatible, safe and suitable for skin cells to attach to and grow. The scaffold could be used for repairing the damaged dermal bed or for engineering an autologous skin substitute in the laboratory with skin structures comparable to normal human skin which includes epidermis, dermal components, pigment cells and microvascular vessels. The research and development of tissue-engineered scaffold, dermal and skin equivalents will benefit not only burns patients but also patients with other skin defects such as chronic diabetic and pressure skin ulcers.