Comparing Autologous Skin Grafting vs. Cultured Epithelial Autografts in Severe Burn Surgery: A Randomized Controlled Trial of Wound Healing and Scarring

Abstract

This randomized controlled trial compared autologous skin grafting (ASG) and cultured epithelial autografts (CEA) in patients with severe burns. A total of 120 patients with burns involving more than 30% of the total body surface area were randomly assigned to ASG (n = 60) or CEA (n = 60). Primary outcomes included wound healing time, 2-week graft survival, and Vancouver Scar Scale (VSS) scores at 3 and 6 months. Secondary outcomes included postoperative pain, complications, and serum biomarkers. Baseline characteristics were comparable between groups. Compared with ASG, CEA was associated with a longer wound healing time and lower 2-week graft survival. However, VSS scores at both follow-up time points were significantly lower in the CEA group. Postoperative pain at 72 hours and complication rates were also lower in patients treated with CEA. In addition, epidermal growth factor and transforming growth factor-β1 levels were higher, while C-reactive protein levels were lower in the CEA group at 3 days postoperatively. In conclusion, although CEA results in delayed wound healing, it offers improved scar quality, reduced pain, and fewer complications, and may serve as an effective alternative for severe burn patients with limited donor skin.