The use of human deceased donor skin allograft in burn care

Abstract

Burns are tissue wounds caused by thermal, electrical, chemical cold or radiation injuries. Deep injuries lead to dermal damage that impairs the ability of the skin to heal and regenerate on its own. Skin autografting following burn excision is considered the current gold standard of care, but lack of patient's own donor skin or unsuitability of the wound for autografting may require the temporary use of dressings or skin substitutes to promote wound healing, reduce pain, and prevent infection and abnormal scarring. These alternatives include deceased donor skin allograft, xenograft, cultured epithelial cells and biosynthetic skin substitutes. Allotransplantation is the transplantation of cells, tissues, or organs, sourced from a genetically non-identical member of the same species as the recipient. Human deceased donor skin allografts represent a suitable and much used temporizing option for skin cover following burn injury. The main advantages for its use include dermoprotection and promotion of reepithelialisation of the wound and their ability to act as skin cover until autografting is possible or re-harvesting of donor sites becomes available. Disadvantages of its use include the limited abundance and availability of donors, possible transmission of disease, the eventual rejection by the host and its handling storing, transporting and associated costs of provision. This paper will explore the role of allograft skin in burn care, defining the indications for its use in burn management and the future potential for allograft tissue banking.

Current insights into skin banking: storage, preservation and clinical importance of skin allografts

“…Human cadaver skin grafts are therefore still the best alternative for wound coverage. [12][13][14] Moreover, as the median age of the population increases, the number of people with hard-to-heal wounds, such as posttraumatic wounds in patients with diabetes or on long-term therapy with high-dose corticosteroids, chronic venous and pressure ulcers, is increasing. The increasing demand for donor skin grafts to manage severe burns, trauma and soft tissue injuries has led to the creation of skin banking facilities, 14 stimulating research into skin processing methods.…”

“…The increasing demand for donor skin grafts to manage severe burns, trauma and soft tissue injuries has led to the creation of skin banking facilities, 14 stimulating research into skin processing methods. [12][13][14][15][16][17] All patients provided written informed consent for their accompanying images to be published for this review.…”

‘Getting under our skin’: Introducing banked allograft skin to burn surgery in South Africa

“…Once this is achieved, the patient will regain physiological equipoise, and autograft cover is no longer such an urgent priority, but can be performed in a staged, more effective manner. [8][9][10][11] Allograft is also an excellent 'test of the wound bed' . If the skin 'takes' , it is probable that the autograft will also take, therefore reducing the likelihood of autograft loss and optimising the critical resource that is the patient's donor sites.…”

“…[5][6][7][8] Although the most important indication is undoubtedly in the context of the major burn, there are a number of other scenarios where an allograft may contribute substantial value in clinical practice ( Table 1). [9,11] Figs 1 -3 demonstrate the advantage of sheet grafting a dorsal hand burn after debridement, prior to Deceased donor skin possesses many of the properties of the ideal biological dressing, and a well-stocked skin bank has become a critically important asset for the modern burn surgeon. Without it, managing patients with extensive burns and wounds becomes far more challenging, and outcomes are significantly worse.…”

The Effects of Constant Flow Bioreactor Cultivation and Keratinocyte Seeding Densities on Prevascularized Organotypic Skin Grafts Based on a Fibrin Scaffold

“…3 To address these issues, two stepped procedures have been established in the clinic: Allogenic donor skin 4 or various artificial collagen-based dermal substitutes 5 offer immediate coverage on large burned areas, but have to be covered subsequently with STSGs to obtain a permanent wound enclosure. Therefore, a one-step procedure is desirable.…”