Cryopreserved Dermis is an Ideal Substrate for the Engraftment and Maturation of Human Epidermal Keratinocyte Cultures

Abstract

AbstractThe ideal replacement for skin damaged by full-thickness injury is the split-thickness autograft. In extensive burns, use of autograft is limited by the availability of uninjured donor skin. This limitation can be overcome by grafting viable cryopreserved cadaveric skin following escharectomy. To preclude immunologic rejection of the allograft, the epidermis is later removed by abrasion and replaced with autologous keratinocyte cultures. The cultures rapidly stratify and within 7 days form a differentiated epidermis of normal thickness. Over several weeks the basement membrane zone reconstitutes normally by several criteria including the presence of a lamina densa and of anchoring fibrils and immunohistochemical demonstration of type IV collagen and laminin. Melanocytes, which are present in small numbers in the keratinocyte cultures. assume their normal position and function in the epidermis of the composite graft. Langerhans cells migrate into the autologous cultured keratinocyte graft.Autologous keratinocytes can be greatly expanded in cell culture and used as grafts to resurface large areas. The functional quality of such grafts however is dependent on the ability of the dermal substrate to support the permanent engraftment of keratinocyte cultures through reconstitution of a normal basement membrane zone.