Estabelecimento de protocolo para armazenamento de pele autógena refrigerada / Establishment of a protocol for storage of refrigerated autologous skin

Introdução: Enxertos de pele autólogos são utilizados em tratamento de pacientes queimados. Esses enxertos podem ser armazenados e preservados, desde que o processo de armazenamento seja realizado com rígido controle de qualidade, para garantir a redução dos riscos de infecção. Métodos: Foi realizado um estudo de coorte retrospectivo na Unidade de Queimados do Hospital das Clínicas de São Paulo no período de fevereiro de 2015 a julho de 2016, em que foi estabelecido um protocolo para armazenamento de pele refrigerada com controle de coleta, preservação, embalagem e registro de todos os processos. Para garantia de qualidade, foram coletadas biópsias dos enxertos para microbiologia pré e pós-armazenamento e realizado um estudo transversal de prevalência de contaminação pré e pós-estocagem. Resultados: Os pontos críticos encontrados foram inadequação de embalagem, ausência de registros de processos, falta de coleta de biópsias para microbiologia e falhas no descarte. A maior parte das amostras estava contaminada tanto pré como pós-estocagem (84,2%). Apenas dois pacientes apresentaram microbiologia estéril no pré e contaminada no pós, porém foram encontrados germes da pele do tipo gram+. Conclusão: Foi estabelecido um método promissor de armazenamento de pele refrigerada que necessita alguns pequenos ajustes para adequação ao controle de qualidade.

Introduction: Autologous skin grafts are used for treatment of burn patients. These grafts can be stored and preserved, as long as the storage process is performed with strict quality control to reduce the risk of infection. Methods: A retrospective cohort study was conducted in the Burn Unit of the Hospital das Clínicas de São Paulo from February 2015 to July 2016. During this period, a protocol was established to store refrigerated skin, with control of collection, preservation, and packaging, and recording of all processes. To ensure quality, graft biopsies were collected for pre- and poststorage microbiology testing and a cross-sectional study for contamination was performed. Results: Critical deficiencies included inadequate packaging, lack of processing records, lack of biopsies for microbiology testing, and failure to discard specimens. Most of the samples were contaminated before and after storage (84.2%). Only two samples were sterile before storage but became contaminated after storage, with growth of Gram-positive skin bacteria. Conclusion: A promising method for the storage of refrigerated skin was established, but requires minor adjustments in quality control.

[Informed consent to postmortem tissue donation: a catamnestic survey within a year of the donor's death]. / Die muskuloskelettale Gewebespende: Rückblickende Bewertung durch die Angehörigen des Spenders im Jahresabstand nach dem Tod.

UNLABELLED: The authors present data from 36 musculoskeletal donors. Talking to the next of kin plays a key role in the consenting process for tissue donation. We give an overview of our fundamental thoughts and the guidelines developed for the contact with the family and present the results of a catamnestic review. METHODS: One year after procurement, we contacted the consenting persons by telephone for an interview using a semi-standardized questionnaire to evaluate the information given on tissue donation and the emotional processing of the death. RESULTS: 8-18 months after the donation, 26 (72.2 %) consenting persons could be reached and gave a positive feedback with regard to the information and support provided and the consent given by them at that time. DISCUSSION: The telephone contact of physicians from an Institute of Legal Medicine with the family of a deceased is perceived as being helpful in an acute stress situation caused by a sudden death and as an accepted way to ascertain the deceased's last will with regard to a potential musculoskeletal donation. According to the German Transplantation Act asking for musculoskeletal donations is the duty of every physician. Our data show that this does not constitute an additional burden for the relatives, if the question is asked in an appropriate way.

Evolving practice of the Helsinki Skin Bank.

The purpose of this study is to review the management and running of the Helsinki Skin Bank between the years 2001 and 2008. Further aims were to assess the microbiological safety of the glycerol-preserved allograft skin and analyse its clinical use. The files of the Helsinki Skin Bank were reviewed for allograft skin harvested from organ donors between 2001 and 2008. Data on harvested skin area and microbiological culture results were collected. The patients receiving allograft were also identified and operation indications analysed. Allograft skin was collected from 115 donors, with a mean of 44,335 cm(2) per year. No skin batches were discarded. Microbiological cultures of the allograft skin batches were negative in 86 (75%) cases. Thirty-five donor skin batches were used in 69 operations. The most common indication was 'Biological dressing on partial-thickness burns', comprising 52% of cases. The cost per cm(2) was 0.81euro. The use of allograft skin in the Helsinki Skin Bank is microbiologically safe and continues to provide a versatile and useful treatment modality in many major burn cases with few observed complications. As compared with synthetically produced temporary dressings currently available, our allograft skin is also more economical.

Organización y funcionamiento del primer banco de piel en Argentina, oficialmente autorizado / Organize and function skin banks officially authorized in Argentina

Desde principios de este siglo aparecen en la bibliografía internacional publicaciones relacionadas con la conservación de piel para su empleo como homoinjertos en el tratamiento de las quemaduras graves. A partir de la década del 50 se encuentran datos referidos a la posibilidad de organizar bancos para el almacenamiento de piel. A partir de 1980 se elaboran protocolos detallados para el procesamiento, almacenaje y ulterior empleo de la piel conservada. En nuestro país, la Fundación del Quemado Fortunato Benaim ha podido concretar la instalación de un Banco de Piel que se ajusta a los requisitos internacionales y es el primero oficialmente autorizado en la Argentina por el INCUCAI, de acuerdo con las disposiciones emanadas de la Ley de Ablación de Implante de Organos y Tejidos

Organización y funcionamiento del primer banco de piel en Argentina, oficialmente autorizado / Organize and function skin banks officially authorized in Argentina

Desde principios de este siglo aparecen en la bibliografía internacional publicaciones relacionadas con la conservación de piel para su empleo como homoinjertos en el tratamiento de las quemaduras graves. A partir de la década del 50 se encuentran datos referidos a la posibilidad de organizar bancos para el almacenamiento de piel. A partir de 1980 se elaboran protocolos detallados para el procesamiento, almacenaje y ulterior empleo de la piel conservada. En nuestro país, la Fundación del Quemado Fortunato Benaim ha podido concretar la instalación de un Banco de Piel que se ajusta a los requisitos internacionales y es el primero oficialmente autorizado en la Argentina por el INCUCAI, de acuerdo con las disposiciones emanadas de la Ley de Ablación de Implante de Organos y Tejidos

[Human allogeneic cultured epidermis: medico-legal considerations]. / Epidermide umana coltivata allogenica: considerazioni medico-legali.

The possibility of cultivating in vitro human kerathinocytes has opened new prospectives in the surgical treatment of major burns and, generally, in patients with extensive skin loss (degloving, etc.). Epidermidal sheets, obtained in vitro, have been used initially, successfully, as autografts. Later, their peculiar immunological characteristic (absence of Langerhans cells expressing class II MHC antigens and inability of evocating omograft rejection) has allowed it's use as allograft without the need of resorting to treatment with immunosuppressive drugs. Medico-legal problems raised by the use of human epidermys cultivated as allograft are described hereafter.