The Skin Bank

When a person sustains an extensive and/or deep wound, the trick to faster healing is to use prompt surgical excision of the dead and burned tissue and to immediately  cover the healthy tissue with a skin graft.  There are two types of skin grafts: 1) an autograft, in which healthy skin from the burn victim is excised in a split thickness fashion to be used as a “mesh-like” covering over the wound, and 2) an allograft, in which skin from a cadaver donor is used as a temporary measure until the person’s own skin can grow.
 
Grafts like these have been used with some success since the late 1880s.
 
Skin was able to be stored beginning in the early 1990s by refrigeration.  By 1949, modern day skin banking developed with the opening of the United States Navy Tissue Bank.  By 1952, methods were found to store skin using glycerol, which prevented damaging ice crystals from building  up in the frozen donor skin.  The first functional skin bank was created privately in 1971.
 
Using Allograft (Donor) Skin
 
There are several reasons why a person might need donated skin to protect open tissue from the elements and dangerous pathogens.  These include the following:
  • Covering mesh-like autografts
  • Covering extensively burned areas
  • Covering partial thickness burns
  • Extensive loss of skin in diseases like toxic epidermal necrolysis and staphylococcal scalded skin syndrome
  • As a template for laying down keratinocytes
These kinds of skin grafts reduce fluid loss from the body surface, keep the wound from getting dried out, and prevent bacterial infections of the wound.  The wound hurts less and it heals faster.
 
Allografts promote the growth of the patient’s own skin and can prepare a burn wound for final closure.
 
The best type of allograft is the fresh allograft—one that has not been frozen. Unlike autografts, which look like mesh when applied, autografts are whole pieces of skin.  They are able to promote their own circulation and nourish the wound for a period of time after being applied.  Fresh allografts adhere better to the underlying tissue.  Once the recipient’s tissue has begun to heal, the allograft can be removed.  The main disadvantage of fresh allograft skin is that the fresh skin only lasts 14 days in storage and so having enough fresh skin around can be very difficult at times.
 
As mentioned, allograft skin can be used to cover widely meshed patient skin.  The patient skin is laid down onto the subcutaneous tissue and is stretched out like mesh.  Allograft skin is laid upon the autograft skin for better protection and faster healing.
 
A good use of frozen allograft skin is in the covering of partial thickness burns.  In such cases, there is plenty of capillary circulation in the remaining dermis of the patient’s skin and all that is needed is the coverage to prevent the burn from drying out or getting infected.  It can also be used in conditions where the upper layer of skin has sloughed off in staphylococcal scalded skin syndrome or in toxic epidermal necrolysis.  It spares the patient from having a second wound made from harvesting an autograft.
 
Micrografting Techniques
 
One technique, more commonly used in Asia, involves mincing up pieces of autograft skin into tiny pieces and laying the pieces on autograft skin, which is then flipped over and placed on the wound.  This maximizes the healing process.  The downside is that it has the potential to cause severe contraction of the skin once it has healed.
 
Disadvantages of Allograft Skin Use
 
Allograft skin is considered less effective than being able to use the patient’s own skin for the protection of the burned area.  It has a greater incidence of bacterial infections than autograft skin.  For this reason, allograft skin is routinely cultured to make sure it isn’t contaminated.  Cytomegalovirus has also been reported to be transmitted from host allograft skin to recipient. 
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