Mid-term results with cultured epidermal autografts, allogenic skin transplants and cyclosporin A medication.

Transplantation of allogenic split thickness skin grafts (STSG) and immunosuppression with cyclosporin A enable early and definitive skin replacement of extensive, deep partial and full thickness burns. Covering burn defects with definitely engrafted, allogenic dermis and cultivated epithelial autografts (CEA) permits the subsequent withdrawal of cyclosporin A medication. Light-microscopy examination of biopsies, taken 12 and 24 months postgrafting, and electron microscopy of biopsies taken 12 months postgrafting, demonstrates a re-established, but somewhat reduced anchoring of the CEA as compared with a normal epidermal-dermal junction. Clinical inspection, 20 months postgrafting, confirms the histological observations that epifascial transplantation is qualitatively inferior to placing the allogenic STSG on the subcutaneous tissue. In the first situation, the dermis is inelastic and collagen deposition is excessive, whereas in the second case collagen deposition is comparatively reduced and the dermis shows clinically some elasticity.