title: The use of cultured epithelial autograft in the treatment of major burn injuries: a critical review of the literature.
abstract: BACKGROUND
  The need to achieve rapid wound closure in patients with massive burns and limited skin donor sites led to the investigation of in vitro cellular expansion of keratinocytes. The use of cultured epithelial autografts (CEA) was first reported in the treatment of major burns in 1981. Since that time, support for the use of CEA has varied, ranging from 'a useful agent' to having 'no demonstrable effect on the outcome of extensively burned patients'.
  
  
  METHODS
  This critical review of the literature examines issues associated with the use of CEA and the introduction of the technology into clinical practice. The factors potentially limiting the use of cultured CEA are the time necessary to culture CEA sheets, the reliability of 'take', vulnerability of grafts on the newly healed surface, long-term durability and the cost implications of such treatment. The available literature was located and critically evaluated using the Australian National Health and Medical Research Council Guidelines.
  
  
  RESULTS
  In the identified literature, the level of evidence to support the use of CEA in major burn injures is limited and often restricted to case studies and case series with no Level 1 evidence currently available.
  
  
  CONCLUSIONS
  The main question arising 'Does CEA have a role in the treatment of major burns?' has proven difficult to answer due to the wide variation in both the quality of study design and the findings. At best, the literature review has highlighted areas of concern that have hindered the successful use of CEA. Our review critically evaluates the use of CEA and explores the advances in techniques towards attempting to improve reliable clinical implementation of CEA. The need for higher level research into the use of CEA is emphasised by this review.
authors.affiliation: Burn Service WA, Royal Perth Hospital, Princess Margaret Hospital for Children, University of Western Australia, GPO Box X2213, Perth Western Australia 6847, Australia. fionaw@mccomb.org.au
authors.forename: F M
authors.initials: FM
authors.lastname: Wood
authors.forename: M L
authors.initials: ML
authors.lastname: Kolybaba
authors.forename: P
authors.initials: P
authors.lastname: Allen
mesh_terms: D002056:Burns / Q000601:surgery*; D002478:Cells, Cultured; D004847:Epithelial Cells / Q000637:transplantation; D006801:Humans; D016038:Skin Transplantation / Q000379:methods*; D014182:Transplantation, Autologous; D016896:Treatment Outcome