Burn treatment, especially for second-degree burns, has a painful and invasive protocol, grafting healthy skin from a patient’s own body onto the wounded area. Yet even as surgical techniques have evolved, split-thickness skin grafting (STSG)—a procedure that removes a thin layer of healthy skin to cover a burn—has remained the backbone of care.

Although effective, traditional grafting comes with well-documented drawbacks: painful donor sites, delayed mobility, long hospitalizations, higher costs, and visible scarring that can persist for years. Research over the past decade has accelerated the search for alternatives.

Autologous skin cell suspension (ASCS), commercially known as Spray on Skin Cells by AVITA Medical, has emerged as an innovative therapy in the burn field. This suspension is created by using a device known as RECELL, which allows surgeons to create a suspension of a patient’s own skin cells from a much smaller donor sample, think ‘as small as a postage stamp,’ which can then be sprayed over the burn wound to promote healing. A growing body of evidence, including a major systematic review and new registry data, suggests this approach not only reduces pain for patients but is also dramatically more efficient for the healthcare system.

Recent findings presented at the 2025 Southern Region Burn Conference underscore this transformation. Data from the Burn Care Quality Platform (BCQP) registry indicates that the use of RECELL can reduce the average hospital length of stay for adults with deep partial-thickness burns by approximately five days compared to traditional grafting. This reduction can have profound implications, from freeing up critical burn beds to generating substantial cost savings.

To understand the real-world impact of these findings, Drug and Device World spoke with Dr. Victoria Miles, a burn surgeon at Louisiana State University Health Sciences Center and the University Medical Center New Orleans, and one of the lead authors of the BCQP study. Here, Dr. Miles discusses the mechanisms behind shorter hospital stays, the impact on quality of life, and what ASCS might mean for the future of burn care.

A Shift Toward Minimally Invasive Burn Care

Dr. Miles frames the advent of RECELL as part of a broader surgical evolution. “Just like we have robotic surgery, just like we have laparoscopic surgery, this is the minimally invasive way that we can treat burns now,” she explains. The core of this shift lies in the drastic reduction of the donor site. Where traditional grafting requires harvesting large areas of skin, RECELL achieves an expansion ratio of up to 80:1, reducing the donor site burden by over 95%.

This fundamental difference changes everything, starting with the surgeon’s willingness to operate earlier. “The patients who received treatment using RECELL went to the OR faster,” Dr. Miles notes, “and I think that’s indicative of the fact that we know as surgeons that the procedure’s not as morbid,” she says. “You’re not committing the patient to a large donor site.”

These observations align with conference data presented by Dr. Miles in September at the 21st Congress of the European Burns Association. The BCQP registry study, focusing on second-degree burns, found that length of stay (LOS) decreased by 4.97 days (38%) for burns up to 10% of total body surface area (TBSA), 6.9 days (35%) for 10–20% TBSA burns, and 7.6 days (31.7%) for 20–30% TBSA burns by using RECELL for treatment.

Healing and Pain: Driving Faster Recovery

The data clearly show patients go home sooner, but the “why” is a combination of accelerated biological healing and significantly reduced pain. Dr. Miles notes that early decision-making associated with the RECELL treatment leads to earlier re-epithelialization. Which means the skin is healing faster and there’s less pain.

The link to pain is direct and powerful. “Our burn patients will stay inpatient when they’re requiring IV medication for pain control, and they can’t leave until they’re not needing that pain medication anymore,” she says.

The primary source of that severe pain is often the donor site, not the original burn. Dr. Miles must preemptively counsel her graft patients about this phenomenon. “I have people who wake up after anesthesia who are so scared because they think I operated on the wrong site…my burn was on my arm, but my thigh hurts so bad [at the donor site].”

By minimizing the size of the donor site, RECELL directly addresses this major source of suffering. This reduction has system-level implications as well:

• Shorter LOS reduces costs, as length of stay is the largest driver of hospital expenditures—not devices, medications or physician fees.
• Earlier mobility improves functional outcomes, which correlates with lower long-term rehabilitation needs.
• Reduced opioid exposure is also an important consideration.

The Quest for Invisible Healing

For Dr. Miles, the modern goal of burn care has evolved beyond simply closing a wound. “In 2025, our goal is no longer to get wounds closed. Our goal, or my goal, is for someone to go to the grocery store and no one to ever know that anything [like a burn and the associated scarring] happened to them,” she says. RECELL is a significant step toward that goal, particularly through two key benefits: reduced scarring and improved skin re-pigmentation.

The technology promotes faster healing, which is intrinsically linked to better scarring. “The longer a wound stays open, the worse scar it’s going to have,” Dr. Miles explains. By enabling earlier surgery and faster re-epithelialization, RECELL sets the stage for less hypertrophic scarring and contracture down the line.

Perhaps the most visually striking benefit, especially for patients with darker skin, is re-pigmentation. The cell suspension contains melanocytes, the cells responsible for skin color. “Until we had RECELL, we didn’t have a great solution for how we repigmenting people’s skin,” Dr. Miles notes. For her patients in New Orleans, many of whom have darker Fitzpatrick skin types, this is transformative.

“The pigment of your skin is very important to your social interactions within your cultural community… when we take the dressings down and their pigmentation’s back, they just cry because they just can’t believe what they’re seeing.” This rapid and natural re-pigmentation, which can begin within a week, is a profound psychological and cosmetic victory, aiding immensely in social reintegration. A UK case series on RECELL also noted “better skin color matching” as a key benefit.

The Economic and Capacity Argument

The clinical benefits are clear, but the health system-level impacts are equally compelling. The BCQP study led by Dr. Miles quantified the economic benefit, estimating that the 5.6-day reduction in length of stay translates to approximately $42,000 in savings per patient. On a systemic level, this LOS reduction means each hospital bed can treat about 13 additional patients per year.

However, Dr. Miles argues that the economic narrative, while important, can obscure an even more critical point: access to care. “The major driver of healthcare costs is length of stay… However, let’s think about you personally. So, let’s say you have a burn and you want to be treated at a specialized burn center. Well, there are only 77 verified burn centers in the US… If all of those beds are full, where do you get your care?”

The capacity created by shorter stays directly translates to greater access for patients in need of specialized burn care. This makes the technology not just a cost-saver, but a potential lifesaver for those who would otherwise be turned away from a full unit, notes Dr. Miles.

What Comes Next: Data Gaps and Future Research

While the RECELL therapy benefits from a strong and growing evidence base, which includes a systematic review of 99 studies and nearly 8,000 patients. It can be used to treat a wide variety of wound conditions, such as burns, STSG donor sites,chronic wounds, hypopigmented scars,vitiligo, and large congenital melanocytic nevus (a non-cancerous dark skin lesion).

 Dr. Miles identifies key areas for further research. She is personally focused on generating more objective data on repigmentation and long-term scarring outcomes.

“We need to be able to track those patients, and that’s going to be a significantly funded study to track long-term outcomes in hypertrophic scars because scars can continue to evolve for months and months,” she says. Furthermore, she sees a need for “more robust outpatient care data” to build algorithms for using RECELL beyond the inpatient setting.

Dr. Miles is confident about the trajectory. “I think in the next decade, or two… I can see RECELL becoming the standard of care.”

The data from the registry and the experiences of surgeons like Dr. Miles suggest that the future of burn care is not just about survival, but about healing faster, with less pain, and returning patients to their lives with their identities and function intact.