Cell and Tissue Banking

, Volume 11, Issue 1, pp 99–104 | Cite as

The use of human deceased donor skin allograft in burn care

  • Jorge Leon-Villapalos
  • Mohamed Eldardiri
  • Peter Dziewulski
Article

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.

Keywords

Burn injury Human skin allograft 

References

  1. Alexander JW, MacMillan BG, Law E et al (1981) Treatment of severe burns with widely meshed skin autograft and meshed skin autograft overlay. J Trauma 21(6):433–438PubMedGoogle Scholar
  2. Andrew Lee WP, Felili-Hariri M, Butler PEM (2007) Transplant biology and applications to plastic surgery. In: Thorne CH (ed) Grabb and Smith’s plastic surgery, 6th edn. Lippincott Williams and Wilkins, Philadelphia, PA, pp 52–57Google Scholar
  3. Atiyeh BS, Hayek SN, Gunn W (2005) New technologies for burn wound closure and healing—review of the literature. Burns 31(8):944–956CrossRefPubMedGoogle Scholar
  4. Barret JP, Dziewulski P, McCauley RL, Herndon DN, Desai MH (1999) Dural reconstruction of a class IV calvarial burn with decellularized human dermis. Burns 25(5):459–462CrossRefPubMedGoogle Scholar
  5. Bert P (1863) De la Greffe Animale. These Medicale, ParisGoogle Scholar
  6. Billingham RE, Medawar PB (1952) The freezing, drying and storage of mammalian skin. J Exp Biol 19:454–468Google Scholar
  7. Blome-Eberwein S, Jester A, Kuentscher M, Raff T, Germann G, Pelzer M (2002) Clinical practice of glycerol preserved allograft skin coverage. Burns 28:S10–S12Google Scholar
  8. Brychta P, Adler J, Rihová H, Suchánek I, Kaloudová Y, Koupil J (2002) Cultured epidermal allografts: quantitative evaluation of their healing effect in deep dermal burns. Cell Tissue Bank 3(1):15–23Google Scholar
  9. Buinewicz B, Rosen B (2004) Acellular cadaveric dermis (AlloDerm): a new alternative for abdominal hernia repair. Ann Plast Surg 52(2):188–194CrossRefPubMedGoogle Scholar
  10. Burd A (2002) Allogenic skin: transplant or dressing? Burns 28(4):358CrossRefPubMedGoogle Scholar
  11. Burd A, Chiu T (2005) Allogenic skin in the treatment of burns. Clin Dermatol 23(4):376–387CrossRefPubMedGoogle Scholar
  12. Burke JF, Bondoc CC, Quinby WC (1974) Primary burn excision and immediate grafting: a method for shortening illness. J Trauma 14:389–395CrossRefPubMedGoogle Scholar
  13. Byrne PJ, Hilger PA (2004) Lip augmentation. Facial Plast Surg 20(1):31–38CrossRefPubMedGoogle Scholar
  14. Callcutt RA, Schurr MJ, Sloan M et al (2006) Clinical experience with Alloderm A one-staged composite dermal/epidermal replacement utilizing processed cadaver dermis and thin autografts. Burns 32(5):58–583CrossRefGoogle Scholar
  15. Demling RH, DeSanti L (1999) Management of partial thickness facial burns (comparison of topical antibiotics and bio-engineered skin substitutes). Burns 25:256–261CrossRefPubMedGoogle Scholar
  16. Eisenbud D, Huang NF, Luke S, Silberklang M, Skin (2004) Substitutes and wound healing: current status and challenges. Wounds 16(1):2–17Google Scholar
  17. Girdner JH (1881) Skin grafting with grafts taken from the dead subject. Med Rec 20:119–120Google Scholar
  18. Gnudi MT, Webster JP (1950) The life and times of Gaspare Tagliacozzi, Surgeon of Bologna, pp 1545–1599. With a Documented Study of the Scientifc and Cultural Life of Bologna in the Sixteenth Century. Preface by Arturo Castiglioni. New York, Herbert ReichnerGoogle Scholar
  19. Gore DC (2005) Utility of acellular allograft dermis in the care of elderly burn patients. J Surg Res 1;125(1):37–41Google Scholar
  20. Hierner R, Degreef H, Vranckx J, Garmyn M, Massagé P, Van Brussel M (2005) Skin grafting and wound healing—the “dermato-plastic team approach”. Clin Dermatol 23(4):343–352Google Scholar
  21. Horch RE, Jeschke MG, Spilker G et al (2005) Treatment of second degree facial burns with allografts—preliminary results. Burns 31(5):597–602CrossRefPubMedGoogle Scholar
  22. Jackson D (1972) Excision and closure of the wound as applied to burns. Proc R Soc Med 65(1):23–24PubMedGoogle Scholar
  23. Janzekovic Z (1970) A new concept in the early excision and immediate grafting of wounds. J Trauma 10:1103–1108PubMedCrossRefGoogle Scholar
  24. Jones I, Currie L, Martin R (2002) A guide to biological skin substitutes. Br J Plast Surg 55(3):185–193CrossRefPubMedGoogle Scholar
  25. Kagan RJ, Robb EC, Plessinger RT (2007) The skin bank. In Herndon DN (ed) Total burn care, 3rd edn. Saunders Elsevier, pp 229–238Google Scholar
  26. Kealey GP, Aguiar J, Lewis RW II et al (1996) Cadaver skin allografts and transmission of human cytomegalovirus to burn patients. J Am Coll Surg 182:201–205PubMedGoogle Scholar
  27. Lexer E (1911) lber freie Transplantationen. Langenbecks Arch klin Chir 95:827Google Scholar
  28. Lowery K, Shirley R, Shelley OP, Kaniorou-Larai M, Philp B, Dziewulski P (2008) Purpura fulminans skin loss: surgical management protocols at a regional burns centre. J Plast Reconstr Aesthet Surg 61(12):1520–1523CrossRefPubMedGoogle Scholar
  29. Mowlem M (1952) Skin homografts. Med Illus 6(11):552–555PubMedGoogle Scholar
  30. Padgett EC (1932) Is Iso-skin grafting practicable? South Med J 25:895Google Scholar
  31. Phama C, Greenwood J, Cleland et al (2007) Bioengineered skin substitutes for the management of burns: a systematic review. Burns 33:946–957CrossRefGoogle Scholar
  32. Pianigiani E, Ierardi F, Taddeucci P, Perotti R, Biagioli M, Di Simplicio FC, Andreassi A, Fimiani M (2002) Skin allograft in the treatment of toxic epidermal necrolysis (TEN). Dermatol Surg 28(12):1173–1176CrossRefPubMedGoogle Scholar
  33. Purdue GF, Hunt JL, Gillespie RW, Hansbrough JF, Dominic WJ, Robson MC, Smith DJ, MacMillan BG, Waymac JP, Herndon DN (1987) Biosynthetic skin substitute versus frozen human cadaver allograft for temporary coverage of excised burn wounds. J Trauma 27(2):155–157CrossRefPubMedGoogle Scholar
  34. Purdue GF, Hunt JL, Still JM Jr, Law EJ, Herndon DN, Goldfarb IW, Schiller WR, Hansbrough JF, Hickerson WL, Himel HN, Kealey GP, Twomey J, Missavage AE, Solem LD, Davis M, Totoritis M, Gentzkow GD (1997) A multicenter clinical trial of a biosynthetic skin replacement, Dermagraft-TC, compared with cryopreserved human cadaver skin for temporary coverage of excised burn wounds. J Burn Care Rehabil 18(1 Pt 1):52–57Google Scholar
  35. Rana RE, Arora BS (2002) History of plastic surgery in India. J Postgrad Med 48:76PubMedGoogle Scholar
  36. Reverdin JL (1871) Sur la greffe epidermique. CR Acad Sci 73:1280Google Scholar
  37. Schone GE (1906) Bruns Beitr KIin Chir 61:1Google Scholar
  38. Spies M, Sanford AP, Aili Low JF, Wolf SE, Herndon DN (2001) Treatment of extensive toxic epidermal necrolysis in children. Pediatrics 108(5):1162–1168CrossRefPubMedGoogle Scholar
  39. Taban M, Douglas R, Li T, Goldberg RA, Shorr N (2005) Efficacy of “thick” acellular human dermis (AlloDerm) for lower eyelid reconstruction: comparison with hard palate and thin AlloDerm grafts. Arch Facial Plast Surg 7(1):38–44CrossRefPubMedGoogle Scholar
  40. Tagliacozzi G (1597) De Curtorum Chirurgia Per InstitionemGoogle Scholar
  41. Tenenhaus M, Rennekampff HO (2007) Burn surgery. Clin Plast Surg 34:697–715CrossRefPubMedGoogle Scholar
  42. Thiersch JC (1886) On skin grafting. Verhandl2nd Deutsch Ges Chir 15:17–20Google Scholar
  43. Tompkins RG, Remensnyder JP, Burkr JF et al (1988) Significant reduction in mortality for children with burn injuries through the use of prompt eschar excision. Ann Surg 208(5):577–585CrossRefPubMedGoogle Scholar
  44. Tsai CC, Lin SD, Lai CS, Lin TM (1999) The use of composite acellular allodermis-ultrathin autograft on joint area in major burn patients—one year follow-up. Kaohsiung J Med Sci 15(11):651–658PubMedGoogle Scholar
  45. Vloemans AFPM, Middelkoop E, Kreis RW (2002) A historical appraisal of the use of cryopreserved and glycerol-preserved allograft skin in the treatment of partial thickness burns. Burns 28:S16–S20CrossRefPubMedGoogle Scholar
  46. Wang H-J, Yeap CL, Heimbach DM (1984) Allograft vs. Xenograft in preparation of wound for autograft. J Burn Care Rehabil 5(2):116–118CrossRefGoogle Scholar
  47. Wentscher JA (1903) A further contribution about the survivavility of human epidermal cells. Dtsch Z Chir 70:21–44Google Scholar
  48. Wolfe RA, Roi LD, Flora JD et al (1983) Mortality differences and speed of wound closure among specialized burn care facilities. J Am Med Assoc 250:37–41CrossRefGoogle Scholar
  49. Zaroff LI, Mills W Jr, Duckett JW Jr, Switzer WE, Moncrief (1966) Multiple uses of viable cutaneous homografts in the burned patient. Surgery 59(3):368–372PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  • Jorge Leon-Villapalos
    • 1
  • Mohamed Eldardiri
    • 1
  • Peter Dziewulski
    • 1
  1. 1.St Andrews Centre for Plastic Surgery and BurnsBroomfield, ChelmsfordUK

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