Case Report: Structural evaluation of skin following use of cultured epithelial autografting by a non-invasive imaging modality

Cultured epithelial autografts (CEA) are a life-saving option for massive burns when skin donor sites are insufficient for split thickness skin grafting (STSG). Long-term skin quality following grafting is usually judged with subjective scar scales or indirect biophysical testing with very limited standardized structural assessment potential. We report the use of optical coherence tomography (OCT) as a non-invasive imaging approach to objectively characterize long-term microstructure in a patient grafted with CEA. A 55-year-old man sustained 73% total body surface area (TBSA) burns with inhalation injury. Management included staged debridement and coverage with 64% TBSA STSG and 88% TBSA CEA, followed by prolonged intensive care and rehabilitation. Five years after injury, OCT imaging was performed using a commercial dynamic OCT device, with triplicate scans acquired at multiple anatomical sites representing full thickness skin grafting, meshed STSG at different expansion ratios, CEA alone, and combined meshed graft plus CEA. Control measurements were obtained from adjacent or contralateral healthy skin when available. Quantitative analysis included vascular plexus depth, vessel diameter, and vessel density, together with epidermal optical parameters, epidermal thickness, epidermal thickness variation, and surface roughness. OCT acquisition was feasible across all examined sites and was rapid and painless. Vascular measurements showed substantial intra-site variability and no consistent differences between grafted and healthy skin, suggesting an important influence of recipient site characteristics. In contrast, epidermal metrics portrayed variables across reconstruction strategies. Most grafted sites fell within the range of healthy skin for epidermal thickness, whereas areas treated with CEA alone displayed a markedly thinner epidermis 23.1 ± 2.5 µm and reduced epidermal thickness variation compared with healthy skin and meshed grafted sites; combined meshed graft plus CEA showed intermediate values. Surface roughness was generally comparable to healthy skin within standard deviation. These findings indicate that OCT can provide objective, rapid and non-invasive structural assessment of reconstructed skin years after burn. This case report also suggest that CEA might yield a persistent thin and uniform epidermal phenotype, warranting confirmation in larger prospective cohorts integrating OCT with functional and patient reported outcomes.