AN ANIMAL-MODEL TO STUDY THE SIGNIFICANCE OF DERMIS FOR GRAFTING CULTURED KERATINOCYTES ON FULL-THICKNESS WOUNDS

Autologous cultured keratinocytes grafted onto full thickness wounds take poorly, and any epidermal cover that is produced is unstable. However, a more stable epidermis has been reported when keratinocytes are grafted onto a dermal surface. We have developed a skin grafting model using a polytetrafluoroethylene (PTTE) skin graft chamber in the domestic pig. The chambers isolate individual wounds and prevent epithelial migration from the wound edge. Dermal grafts were prepared by enzymatic separation of the epidermis from split skin to leave a de-epidermalized dermis (DED). Full thickness wounds were initially grafted with autologous DED and, subsequently, 7 days later with cultured autologous keratinocytes. The wounds were biopsied serially over 6 weeks, and processed for histology, immunocytochemistry and electron microscopy. Clinically, the grafts were seen to mature over the 6-week period. In 14/20 wounds, 40-72 per cent of the wound areas (as assessed by image analysis) had acquired epidermal cover at day 14. In 6/20 wounds, the epidermal cover was 0-27 per cent. The skin surface was stable at day 21. At this time electron microscopy and immunohistochemistry demonstrated a continuous, well formed basement membrane. The epidermis was initially acanthotic, but was histologically mature by day 14. Surprisingly, the dermal grafts were broken down by day 14. However, a neodermis formed beneath all areas with epithelial cover 21 days after grafting the keratinocytes. In this model, we have demonstrated the advantage of providing a dermal bed for cultured keratinocytes.