The Skin Bank

In wound care, particularly when faced with extensive and deep injuries, the key to expediting the healing process lies in prompt surgical intervention. Removing dead and burned tissue, followed by immediate coverage with a skin graft, is a crucial step toward achieving a successful recovery. Skin grafting, a surgical procedure that involves transplanting skin from one area of the body to another, serves as a powerful tool in concealing heavy scars resulting from burns, injuries, or various medical conditions.

There are two primary types of skin grafts, each with its distinct purpose:

1. Autografts: In this method, healthy skin is meticulously excised from the burn victim, typically in a split-thickness manner, to create a "mesh-like" covering over the wound. This approach aids in the restoration of damaged tissue while minimizing the appearance of scars.
2. Allografts: Allografts involve using skin from a cadaver donor as a temporary measure. This donated skin serves as a protective barrier until the recipient's body can regenerate its own skin tissue.

The utilization of skin grafts has a rich history dating back to the late 1880s. Remarkably, the ability to store skin for transplantation only became feasible in the early 1990s through refrigeration techniques. By 1949, advancements in skin preservation included using glycerol to prevent the formation of damaging ice crystals in frozen donor skin. The United States Navy Tissue Bank, established in 1949, marked a significant milestone in the development of modern-day skin banking. It wasn't until 1971 that the first functional skin bank emerged in the private sector.

Several scenarios necessitate allografts to shield open tissue from environmental elements and potential pathogens. These situations include:

• Covering mesh-like autografts
• Addressing extensive burns across large areas
• Managing partial-thickness burns
• Coping with significant skin loss in conditions like toxic epidermal necrolysis and staphylococcal scalded skin syndrome
• Serving as a template for the growth of keratinocytes

Allografts are crucial in minimizing fluid loss from the body's surface, preventing wound desiccation, and averting bacterial infections. Notably, wounds treated with allografts tend to heal faster and cause less pain.

Fresh allografts, which have not undergone freezing, promote the growth of the recipient's skin. These grafts can help prepare a burn wound for final closure. Unlike mesh-like autografts, fresh allografts are whole pieces of skin with their own circulation, nourishing the wound for an extended period. Fresh allografts also adhere better to underlying tissue. However, they come with a limitation - they can only be stored for 14 days, posing challenges in ensuring a constant supply of fresh skin when needed.

Frozen allografts prove invaluable in covering partial-thickness burns. In such cases, the patient's remaining skin often retains sufficient capillary circulation. The primary objective is to provide coverage that prevents the burn from drying out or becoming infected. Additionally, frozen allografts find utility when the upper layer of skin has sloughed off, as seen in conditions like staphylococcal scalded skin syndrome or toxic epidermal necrolysis. Using frozen allografts spares patients from the additional trauma of undergoing autograft harvesting.

More commonly employed in Asian medical practice, micrografting techniques involve mincing small pieces of autograft skin into tiny fragments. These fragments are then placed on autograft skin and flipped over to cover the wound. This approach maximizes the healing process but may lead to skin contraction once the healing is complete.

While allograft skin can be a lifesaver, it is generally considered less effective than using the patient's skin for protection. Allografts carry a higher risk of bacterial infections than autografts, necessitating routine culturing to ensure they remain uncontaminated. Furthermore, there has been cytomegalovirus transmission from the host allograft skin to the recipient.

This animated video demonstrates a graft procedure to repair damaged skin.

If you have experienced the devastating consequences of severe burn injuries as a result of an accident, reach out to our compassionate team of burn injury lawyers in Sacramento. We understand the physical, emotional, and financial challenges accompanying such injuries, and we are here to provide you with the support and guidance you need during this difficult time. Your well-being and seeking justice are our top priorities. For a confidential and no-obligation consultation, please call us at (916) 921-6400 or toll-free at (800) 404-5400. We are here to offer you not only legal expertise but also the empathy and understanding that you deserve.

^{Editor's Note: updated 11.2.23 Photo by WhiteSession on Pixabay [cs 781]}