Burns therapy with surgical excision and skin grafting is a surgical technique in that it treats the burns wounds with a surgical method. 

Surgical technique, in essence, treats disease through a destructive means while prioritizing the survival of the patient about the importance of the appearance and function of the burned limb. 

Before BRT with MEBT/MEBO was invented, surgical burns therapy had become a major method of burns treatment. 

However, subsequent to the invention of burns regenerative medicine and therapy helpful comparisons have been made between both modalities. 

Impartial investigators have learned that deep second-degree burns wounds should no longer be treated with surgical therapy because burns regenerative medicine and therapy is objectively superior to the surgical approach.

One remaining indication for the use of surgical excision and skin grafting for the treatment of burns may involve third-degree burns with surviving subcutaneous tissues. 

This, however, must only be done after prudent consideration. 

The indication of surgical burns therapy should now be defined as: severe large-area burns reaching the lower layer of superficial fascia. 

Surgical burns therapy should no longer be the major method of burns treatment.

This new technique aims at overcoming the difficulty of the incorporation of the cultured epithelial auto-graft into the burns wound. This technique can effectively prevent ‘autograft exfoliation’ and secondary ulceration. 

The doctors of the laboratory of Culture Technology, Inc., Sherman Oaks, Calif., USA, harvested two components of the skin, autologous keratinocytes and fibroblasts from burns patients and cultured them to enhance proliferation, and then combined them to form epidermal and dermal matrix. Once grown to confluence, the composite autografts are ready for application to the burn wound.

These results were published in Burns 1999;25:771–779. This technique had been successfully applied in the treatment of large-area burns after surgical excision in the Burn Center in Arizona State. 

While this is a significant step forward, we must acknowledge that its treating principle is the same as that of surgical burns therapy.

It protects the autograft but cannot avoid the damage or disablement caused by excision. 

Another comparable disadvantage to this technique is its expense.

Therefore, indication for this technique (skin grafting) should be third-degree burns and burns in the muscle layer. 

This skin grafting using cultured composite autografts after surgical excision should not be considered a major method of burns treatment.