How to improve donor skin availability: Pragmatic procedures to minimize the discard rate of cryopreserved allografts in skin banking

ABSTRACT Background: In the absence of xenograft and biosynthetic skin substitutes, deceased donor skin allografts is a feasible option for saving life of patient with extensive burn injury in our country. Aims: The first deceased donor skin allograft bank in India became functional at Lokmanya Tilak Municipal (LTM) medical college and hospital on 24th April 2000. The response of Indian society to this new concept of skin donation after death and the pattern of utilization of banked allografts from 2000 to 2010 has been presented in this study. Settings and Design: This allograft skin bank was established by the department of surgery. The departments of surgery and microbiology share the responsibility of smooth functioning of the bank. Materials and Methods: The response in terms of number of donations and the profile of donors was analyzed from records. Pattern and outcome of allograft utilization was studied from specially designed forms. Results: During these ten years, 262 deceased donor skin allograft donations were received. The response showed significant improvement after counselling was extended to the community. Majority of the donors were above 70 years of age and procurement was done at home for most. Skin allografts from 249 donors were used for 165 patients in ten years. The outcome was encouraging with seven deaths in 151 recipients with burn injuries. Conclusions: Our experience shows that the Indian society is ready to accept the concept of skin donation after death. Use of skin allografts is life saving for large burns. We need to prepare guidelines for the establishment of more skin banks in the country.

Download Full-text

Skin Banking in Autologous Breast Reconstruction

Plastic & Reconstructive Surgery ◽

10.1097/prs.0b013e31817073f4 ◽

2008 ◽

Vol 121 (6) ◽

pp. 2177-2178 ◽

Cited By ~ 2

Author(s):

Stephen J. Kovach

Keyword(s):

Breast Reconstruction ◽

Autologous Breast Reconstruction ◽

Skin Banking

Download Full-text

The immunogenicity of glycerol-preserved donor skin

Burns ◽

10.1016/0305-4179(94)90095-7 ◽

1994 ◽

Vol 20 ◽

pp. S71-S76 ◽

Cited By ~ 10

Author(s):

R. Hettich ◽

A. Ghofrani ◽

B. Hafemann

Keyword(s):

Donor Skin

Download Full-text

Burn Injury Alters Epidermal Cholinergic Mediators and Increases HMGB1 and Caspase 3 in Autologous Donor Skin and Burn Margin

Shock ◽

10.1097/shk.0000000000000752 ◽

2017 ◽

Vol 47 (2) ◽

pp. 175-183 ◽

Cited By ~ 6

Author(s):

Casey J. Holmes ◽

Jennifer K. Plichta ◽

Richard L. Gamelli ◽

Katherine A. Radek

Keyword(s):

Caspase 3 ◽

Burn Injury ◽

Donor Skin

Download Full-text

Skin grafting in the treatment of hard-to-heal leg ulcers

Italian Journal of Wound Care ◽

10.4081/ijwc.2018.18 ◽

2018 ◽

Vol 2 (1) ◽

Cited By ~ 1

Author(s):

Giovanni Mosti ◽

Vincenzo Mattaliano ◽

Pietro Picerni ◽

Costantino Christou

Keyword(s):

Ulcer Healing ◽

Healing Rate ◽

Skin Grafting ◽

Leg Ulcers ◽

Clinical Routine ◽

Ulcer Size ◽

Donor Skin ◽

Post Traumatic ◽

Chronic Leg Ulcers

Some risk factors or comorbidities may make Chronic Leg Ulcers (CLU) very difficult to heal. These ulcers are usually defined refractory ulcers and may require an in-hospital intensive care to increase the healing rate. Aim of this retrospective study was to assess if our clinical routine in hospitalized patients, made up with surgical debridement followed by donor skin grafting (allografts), may favor the ulcer healing. The records of 120 patients (55 males and 65 females; mean age 73.9±11.3 years) with ulcers greater than 100 cm2 and lasting for more than 1 year were analyzed. The median ulcer size was 165 cm2 (IQR 130-250 cm2; range 100-1000 cm2). The median ulcer duration was 24 months (IQR 16-32 months; range 12-300 months). The ulcer pathophysiology was venous in 74 patients, arterial in 21, mixed in 12, vasculitis in 5 and post-traumatic in 8 patients. After debridement the patients were submitted to allograft procedures (single or multiple) up to the ulcer healing. When allograft was able to create an effective granulation tissue and reduce the ulcer size an autograft was performed to get the ulcer closure. 109 patients healed and 11 were lost at follow-up. 65 patients healed just with one allograft in 16 weeks (IQR 13-21 weeks). 42 patients healed with 2 procedures in 20 weeks (IQR 18-23 weeks). 31 of them received a final autograft while 11 healed with two allografts. 2 patients with an ulcer surface of 200 cm2, both affected by CLI, healed with 3 allografts procedures in 40 and 33 weeks, respectively. Pain and exudate amount were significantly decreased and even disappeared after the first allograft. Allografts alone or followed by an autograft are able to get the ulcer healing also in case of extensive and long lasting ulcers refractory to all previous treatments.

Download Full-text

Donor-Specific Regulatory T Cell-Mediated Immune Tolerance in an Intrahepatic Murine Allogeneic Islet Transplantation Model with Short-Term Anti-CD154 mAb Single Treatment

Cell Transplantation ◽

10.1177/0963689720913876 ◽

2020 ◽

Vol 29 ◽

pp. 096368972091387 ◽

Cited By ~ 2

Author(s):

Seok-Joo Lee ◽

Hyun-Je Kim ◽

Na-ri Byun ◽

Chung-Gyu Park

Keyword(s):

Islet Transplantation ◽

Immune Tolerance ◽

Treg Cells ◽

Transplantation Tolerance ◽

Single Treatment ◽

Short Term ◽

Donor Skin ◽

First Time ◽

Mixed Lymphocyte Reactions ◽

Transplantation Model

Anti-CD154 blockade-based regimens remain unequaled in prolonging graft survival in various organ transplantation models. Several studies have focused on transplantation tolerance with the anti-CD154 blockade, but none of these studies has investigated the mechanisms associated with its use as the sole treatment in animal models, delaying our understanding of anti-CD154 blockade-mediated immune tolerance. The purpose of this study was to investigate the mechanism underlying the anti-CD154 monoclonal antibody (mAb) blockade in inducing immune tolerance using an intrahepatic murine allogeneic islet transplantation model. Allogeneic BALB/c AnHsd (BALB/c) islets were infused into the liver of diabetic C57BL/6 (B6) mice via the cecal vein. Anti-CD154 mAb (MR1) was administered on −1, 0, 1, 3, 5, and 7 d posttransplantation at 0.5 mg per mouse. We showed that short-term MR1 monotherapy could prolong the allogeneic islet grafts to more than 250 d in the murine intrahepatic islet transplantation model. The second islet grafts transplanted under the kidney capsule of the recipients were protected from rejection. We also found that rejection of same-donor skin grafts transplanted to the tolerant mice was modestly delayed. Using a DEREG mouse model, FoxP3+ regulatory T (Treg) cells were shown to play important roles in transplantation tolerance. In mixed lymphocyte reactions, Treg cells from the tolerant mice showed more potency in suppressing BALB/c splenocyte-stimulated Teff cell proliferation than those from naïve mice. In this study, we demonstrated for the first time that a short-term anti-CD154 mAb single treatment could induce FoxP3+ Treg cell-mediated immune tolerance in the intrahepatic murine allogeneic islet transplantation model.

Download Full-text

Article Commentary: Optimizing Aesthetic Results in Skin Grafting

The American Surgeon ◽

10.1177/000313481207800229 ◽

2012 ◽

Vol 78 (2) ◽

pp. 151-154 ◽

Cited By ~ 7

Author(s):

Ron Hazani ◽

Ryan Whitney ◽

Bradon J. Wilhelmi

Keyword(s):

Donor Site ◽

Skin Grafting ◽

Donor Site Morbidity ◽

Secondary Intention ◽

Donor Skin ◽

Aesthetic Results ◽

The Aesthetic ◽

Sheet Graft ◽

Surrounding Skin ◽

Tissue Defects

The aesthetic goal in skin grafting is to provide a cosmetically pleasing coverage of soft tissue defects while minimizing donor site morbidity. A skin graft should blend well with the color and texture of the surrounding skin, reduce wound size, and not interfere with the function of the reconstructed part. This review examines the key components of choosing the appropriate donor skin for a variety of defects. The decision-making process is based on the anatomic location of the defect; donor site availability; and graft size, thickness, and pigmentation. The aesthetic implications of using a sheet graft versus a meshed graft versus an expanded graft are discussed. Aside from addressing the aesthetic needs of the defect, attention is paid to the functional goals of the reconstructed part and reduced donor site morbidity. Partial graft failure can have significant deleterious effects on the aesthetic outcome of skin grafts. The need for further grafting or healing by secondary intention may result in additional scarring and deformity. Recommendations for improvement in graft take and infection control are presented.

Download Full-text

Double rhomboidal flap for reconstruction of large surgical defect of the labial commissure

Anais Brasileiros de Dermatologia ◽

10.1590/s0365-05962012000300015 ◽

2012 ◽

Vol 87 (3) ◽

pp. 456-458 ◽

Cited By ~ 2

Author(s):

Pedro Andrade ◽

Ana Brinca ◽

Ricardo Vieira ◽

Américo Figueiredo

Keyword(s):

Basal Cell Carcinoma ◽

Cell Carcinoma ◽

Male Patient ◽

Surgical Complications ◽

Simple Procedure ◽

Donor Skin ◽

Surgical Options ◽

Total Preservation ◽

The Right ◽

Oral Commissure

Closure of perioral surgical defects involving the oral commissures is highly challenging. We describe a 69-year-old male patient with a large basal cell carcinoma of the right perioral region, extending to the right oral commissure. This lesion was radically excised, and the resulting surgical defect was closed using a homolateral double opposing rhomboidal flap. The final result was esthetically very satisfactory, with total preservation of lip function. Double opposing rhomboidal flaps are viable surgical options for the reconstruction of surgical defects involving the perioral area and oral commissures. In this relatively simple procedure, donor skin is obtained from the nearby cheek and mandibular areas, under low risk of surgical complications, preserving lip function without distortion of the labial anatomy.

Download Full-text