Low-cost and efficient culture environments comparable to standard techniques would undoubtedly improve burn outcomes in underresourced settings. The aim of this case series was to report on the cultured epithelial autografting (CEA) graft-take using a modified composite culture technique. Cultured epithelial autografting transplants, following emergency ethical approval, occurred for patients with burns (n = 25) with low survival prognosis and/or exhausted donor sites. Keratinocytes were retrieved from skin biopsies, seeded centrally on routinely used dressing gauze, and incubated at 37 °C in pediatric incubators. Fresh autogenous plasma was applied daily and hydrogel every third or fourth day. After confluence, the CEA was transplanted onto debrided wound beds. Xenografts were used for temporary cover during the culture period. Final graft take assessment (21 days) was assessed and calculated as a graft take percentage for total CEA area transplanted. Central indices were described as mean (95% confidence interval [CI]) and frequency (%) for age, total body surface area, abbreviated burn severity index scores, survival prognosis, and graft take. Eleven patients survived with a mean age of 36.1 years (95% CI: 25.8-46.4), 45.0% total body surface area burns (95% CI: 35.1-54.9), 9.7 abbreviated burn severity index scores (95% CI: 8.6-10.8), and 79.5% graft take (95% CI: 62.9-96.0). Reduced graft take (61.2%) was observed in patients with perineum burns and increased graft take (97%) in uncomplicated burns. The average CEA graft take was 79.5% using a low-cost culture technique and was comparable to the largest case series in the literature. The survival of the major burn cases was highly favorable considering injury severity, expected outcomes without CEA and the observed challenges.

Cultured epithelial autograft applications are limited by the associated cost and time constraints in resource-limited settings. A modified composite technique using the patients’ own tissue and Cutimed Sorbact dressing was employed as a life-saving emergency measure. Since the non-Caucasian population was more commonly treated at the center, it was important to report the first Caucasian patient outcome, as the graft-take outcome for all populations was unknown. A 54-year-old male with extensive flame burns and a low chance of survival was admitted to the Tygerberg Burn Center. He received traditional skin grafts and cultured epithelial cells, after the 2 week-culture period using the current technique. Short- (⩽2 weeks) and long-term graft take (⩽8 years) was inspected. Good graft take and complete epithelialization was observed during short-term inspection with partially healed areas initially attributed to extensive burn depth and dressing removal. Long-term follow-up indicated a near normal tissue appearance and excellent pliability.

(1) Background: Inhalation injury significantly worsens burn outcomes but lacks a standardized definition and diagnostic consensus, complicating prognosis. Existing diagnostic tools often show limited sensitivity and specificity, reducing clinical utility. This study aimed to identify potential clinical markers, recorded at or shortly after admission, for inhalation injury prognostication. (2) Methods: A retrospective cohort study of 59 burn patients admitted to Tygerberg Hospital’s Burn Centre (South Africa) between 23 April 2016 and 15 August 2017 was conducted. Descriptive statistics were reported based on data type and distribution. Fisher’s exact test, Spearman’s rank correlation (rho), and partial least squares regression (VIP scores) assessed associations, correlations, and predictive value. p < 0.05 (two-tailed) denoted significance. (3) Results: Severe inhalation injury accounted for 61% of admissions (mean 11.2; CI = 9.5–12.9), with a 38.9% mortality rate. Significant associations (p ≤ 0.008) and positive correlations (p ≤ 0.06) were noted for total body surface area (rho = 0.357), complications (rho = 0.690), and burns intensive care unit length of stay (BICU LOS, rho = 0.908). Complications and BICU LOS showed the strongest predictive contributions (VIP = 1.229 and 1.372). Lactate (rho = 0.331, p < 0.011) and hoarseness (rho = −0.314, p < 0.015) correlated significantly but lacked association. (4) Conclusions: Findings suggest elevated lactate may serve as a prognostic marker, while BICU LOS and complications may reflect disease progression. A multi-marker approach is recommended.

Cultured epidermal autografts (CEA) reportedly have better cosmesis than traditional autografts and are especially useful in the absence of healthy skin for grafting. To support cell growth and prevent desiccation during cultivation, CEAs require platelet-rich plasma (PRP), which is typically applied daily for 2 weeks. However, repeated withdrawal of blood may be unfeasible in certain patients, and importantly, the optimal PRP concentration for cell growth remains undefined. Identifying lower, yet effective, concentrations may reduce the need for extensive blood collection. In this in vitro observational pilot study, epidermal cells were enzymatically retrieved from full-thickness skin biopsies, exposed to graded PRP dilutions (0%–100%, v/v), and incubated in pediatric incubators at 37°C for 7 days. Histologic assessments were performed on fixed eosin-stained suspensions using light microscopy (4–100×), and macroscopic features (cell density, gel formation, and fluid volume) were evaluated. PRP concentrations of 50% and 75% produced more viscous suspensions with higher cell-to-gel ratios and better histoarchitecture, including keratinocyte encapsulation, epidermal stratification, dermal fiber development, and adnexal structures. Preliminary findings with PRP concentrations ≥50% demonstrated growth patterns comparable to 100%, suggesting that reduced PRP volumes may still support CEA formation. However, further investigation of low-volume protocols that minimize blood withdrawal without compromising therapeutic efficacy is necessary to establish conclusive evidence.

Cultured epidermal autografts (CEAs) serve as an alternative permanent skin replacement, though high costs often limit their use in resource-constrained settings and to life-saving cases. This case report presents the first documented cosmetic application of a modified CEA technique in a bodybuilder, demonstrating favorable aesthetic outcomes. A 28-year-old Black male with a 20% total body surface area burn sustained in a domestic fire exhibited superficial and deep partial-thickness burns to the face, arms, torso, and feet. Refusing grafts from visible donor sites, treatment using a low-cost modified CEA approach was employed to minimize donor site morbidity. Keratinocytes harvested from a groin biopsy were cultured on Cutimed Sorbact^® (Essity AB, BSN Medical (Pty) Ltd., Pinetown, RSA) dressings with autogenous plasma and hydrogel supplementation and incubated at 37 °C for two weeks. Xenografts provided temporary coverage before CEA transplantation. Graft take was 85%, with minor (15%) loss at 21 days, requiring small autograft coverage. At two months, the Vancouver Scar Scale score was 4, indicating optimal pigmentation, smoother texture, and minimal scarring. These findings align with limited studies on CEAs for cosmetic applications, suggesting this cost-effective technique may broaden the scope of CEAs beyond life-saving interventions to include aesthetic reconstruction, reducing both donor site morbidity and scarring.