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The author compares the outcome of therapy in patients with massive burns with or without cultured autologous epithelial autografts.The use of cultured keratinocytes has been controversial because of poor take and fragility. There have been no prospective series comparing the use of this technology with standard burn wound coverage.During a 5-year period, 22 patients with an average burn size of 71.8% were treated with cultured keratinocytes and compared with a group of 42 controls with an average burn size of 61.6%.There was no significant difference in age, sex distribution, or third-degree component of the burn between the two groups. There was a significantly higher incidence of smoke inhalation in the cultured epithelial autograft group. There was a reduction in mortality in the cultured epithelial autograft group compared with controls, from 48% to 14% (p < 0.007). There was no difference between the two groups in other major complications, or in readmission for breakdown.Coverage of patients who sustain massive burns with cultured autologous epithelial cells is an important and significant advance in management.