ABSTRACT
Allogeneic skin grafting has a history of nearly 150 years and is one of the key measures to repair extensive deep burn wounds. Allogeneic skin survives temporarily to cover the wound, providing a valuable opportunity for the ultimate wound repair using autografts. As the main methods for the repair of extensive deep burn wounds in China, both the microskin grafting technique and inlay skin grafting technique are based on allogeneic skin grafting. Since allogeneic skin is hardly available in recent years, many burn centers are in extreme lack of allogeneic skin, which seriously hampers clinical burn care. Organ Procurement Organization and allogeneic skin banks may be legal means of solving the problems of source and quality of allogeneic skin, and the successful development of ideal engineered skin is the fundamental solution to burn care without allogeneic skin grafting in the future.
ABSTRACT
Objective: To evaluate the advantages of microskin graft using acellular porcine skin for treatment of extensive deep burns by comparing with that using allogeneic skin. Methods: A retrospective analysis was conducted on 70 severe burn patients who were treated in the Second Affiliated Hospital of Kunming Medical University during Jan. 1999 to Jan. 2011. The patients were divided into the acellular porcine skin group and allogeneic skin group, each containing 35 patients. The survival rates of microskin grafts were determined at 4 weeks post-operation. Besides, the rejection of acellular porcine skin and allogeneic skin, changes of body temperature, white blood cell (WBC) count, lymphocyte and serum protein were observed at pre- and post-operation. Results: (1) The survival rate was (71. 5 ± 6. 6)% in acellular porcine skin group and (70. 6 ± 7. 5)% in allogeneic skin group, with no significant difference found between the two groups (P>0. 05). (2) Acellular porcine skin group. At 3 days post-operation the acellular porcine skin was still attached to the wound, most of the skin was not discolorated, and small part of the skin became cinnamomeous. The acellular porcine skin was gradually separated from the auto-microskin at 3-4 weeks post operation, and there was small amount of exudates under the acellular porcine skin, which could be drained through a small cut. In the pressed area, there was still a small amount of exudates, but the acellular porcine skin was not dissolved and the microskin grafts survived and became confluent. (3) Allogeneic skin group. The allogeneic epidermal was rejected and was off from the wound at 3-14 days post transplantation, and at 10-30 days after transplantation the allogenic dermis became dry. During 25-60 days after transplantation, the allogenic dermis was completely stripped off, the microskin grafts became confluent, and the wound was healed. (4) The body temperature of the two groups was significantly descended after operation (P0. 05). Conclusion: Microskin graft using acellular porcine skin, instead of allogeneic skin, for extensive burn patients can inhibit systematic inflammatory response, improve the nutrition condition, and reduce the using of allogeneic skin. Acellular porcine skin might be a suitable alternative for allogeneic skin.
ABSTRACT
Modern wars result in a significant increase in the incidence of burn injury,and a lot of soldiers with extensive deep burn will occur intensively in a short time.At present,allogeneic skin graft is a principal method to treat extensive burn,but allogeneic skin source is in extremely short supply.Therefore,this review concentrates on the source of allogeneic skin,the necessity to establish allogeneic skin bank for preparedness against war,the present existing problems and main solutions to related problems.