Clinical practice and biological effects of keratinocyte grafting.

Skin grafts can be produced in the laboratory from simple sheets of cultured keratinocytes (keratinocyte grafts) or in combination with different mixtures of connective tissue components (composite culture grafts). Autologous keratinocyte grafts have been used most extensively in patients with major body surface burns and have proved life saving. Further attention to clinical factors has improved graft take to 50-60% in optimal circumstances although there is some short term instability of the graft. Keratinocyte autografts can also be used to treat other chronic wounds such as leg ulcers, and surgical excisions. Keratinocyte allografts do not survive transplantation but have effects on wound healing by the release of growth factors and matrix components. Composite grafts have been little used in clinical practice and there are inherent problems with the stability of the matrix components in the presence of high levels of wound collagenases, but banks of allogenic skin grafts may provide temporary cover in burns patients. The roles and clinical indications for keratinocyte grafting are now becoming clear following wider clinical experience.