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Chong SJ, Low ZL, Yick J, Khoo YC, Chua AWC. Achieving self-sufficiency in skin allograft: A Singapore experience. Burns 2024; 50:1062-1067. [PMID: 38402119 DOI: 10.1016/j.burns.2024.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/30/2024] [Indexed: 02/26/2024]
Abstract
AIM This paper describes how Singapore achieved skin allograft self-sufficiency in 2017 by adopting 5 key strategies in 2012. BACKGROUND Singapore General Hospital (SGH) established its own allograft recovery programme in 1998 but was still dependent on overseas allograft procurement. KEY STRATEGIES RESULTS: The allograft recovery programme expanded from 4 to all 20 institutions. Donor referrals increased by 42.9% from 35 in 2014 to over 50 currently. Donor numbers increased by 210%, rising from 4.5 per year before 2015 to an average of 14 per year from 2015 to 2022. The total allografts recovered increased by 223%, climbing from 13,000 to 42,000 annually. Cryopreservation was adopted, extending shelf life to 5.5 years and doubling storage capacity to more than 140,000 cm2 in 2022. CONCLUSION Singapore achieved skin allograft self-sufficiency with no overseas procurement since 2017.
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Affiliation(s)
- Si Jack Chong
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Zhen Luan Low
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore.
| | - Jialin Yick
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Yik Cheong Khoo
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
| | - Alvin Wen Choong Chua
- Department of Plastic, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore
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Šuca H, Čoma M, Tomšů J, Sabová J, Zajíček R, Brož A, Doubková M, Novotný T, Bačáková L, Jenčová V, Kuželová Košťáková E, Lukačín Š, Rejman D, Gál P. Current Approaches to Wound Repair in Burns: How far Have we Come From Cover to Close? A Narrative Review. J Surg Res 2024; 296:383-403. [PMID: 38309220 DOI: 10.1016/j.jss.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 02/05/2024]
Abstract
Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.
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Affiliation(s)
- Hubert Šuca
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Matúš Čoma
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Júlia Tomšů
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jana Sabová
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Robert Zajíček
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Antonín Brož
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martina Doubková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Novotný
- Department of Orthopaedics, University J.E. Purkině and Masaryk Hospital, Ústí nad Labem, Czech Republic; Department of Histology and Embryology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lucie Bačáková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Věra Jenčová
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Eva Kuželová Košťáková
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Štefan Lukačín
- Department of Heart Surgery, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Dominik Rejman
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Peter Gál
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic; Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic; Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovak Republic.
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Holzer PW, Lellouch AG, Moulton K, Zhu L, Ng ZY, Overschmidt B, Gama AR, Leto Barone AA, Rosales I, Monroy R, Cetrulo CL. Clinical Impact of Cryopreservation on Split Thickness Skin Grafts in the Porcine Model. J Burn Care Res 2021; 41:306-316. [PMID: 32074295 DOI: 10.1093/jbcr/irz145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Vital, genetically engineered, porcine xenografts represent a promising alternative to human cadaveric allografts (HCA) in the treatment of severe burns. However, their clinical value would be significantly enhanced if preservation and long-term storage-without the loss of cellular viability-were feasible. The objective of this study was to examine the direct impact of cryopreservation and the length of storage on critical in vivo and in vitro parameters, necessary for a successful, potentially equivalent substitute to HCA. In this study, vital, porcine skin grafts, continuously cryopreserved for more than 7 years were compared side-by-side to otherwise identically prepared skin grafts stored for only 15 minutes. Two major histocompatibility complex (MHC)-controlled donor-recipient pairs received surgically created deep-partial wounds and subsequent grafting with split-thickness porcine skin grafts, differentiated only by the duration of storage. Clinical and histological outcomes, as well as quantification of cellular viability via a series of 3-4,5-dimethylthiazol-2-yl]-2,5 diphenyltetrazolium bromide (MTT) assays, were assessed. No statistically significant differences were observed between skin grafts cryopreserved for 15 minutes vs 7 years. Parametric distinctions between xenografts stored for short- vs long-term durations could not be ascertained across independent clinical, histological, or in vitro evaluative methods. The results of this study validate the ability to reliably preserve, store, and retain the essential metabolic activity of porcine tissues after cryopreservation. Plentiful, safe, and readily accessible inventories of vital xenografts represent an advantageous solution to numerous limitations associated with HCA, in the treatment of severe burns.
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Affiliation(s)
- Paul W Holzer
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA.,XenoTherapeutics, Inc., Boston, Massachusetts, USA.,Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Alexandre G Lellouch
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Laurence Zhu
- XenoTherapeutics, Inc., Boston, Massachusetts, USA
| | - Zhi Yang Ng
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Bo Overschmidt
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Amon-Ra Gama
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Angelo A Leto Barone
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA.,Johns Hopkins Hospital, Johns Hopkins University, Baltimore Maryland, USA
| | - Ivy Rosales
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rod Monroy
- XenoTherapeutics, Inc., Boston, Massachusetts, USA
| | - Curtis L Cetrulo
- Center for Transplantation Science (CTS), Massachusetts General Hospital, Boston, Massachusetts, USA.,XenoTherapeutics, Inc., Boston, Massachusetts, USA
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Abstract
Allograft skin has been widely used for wound management in burn centers. Functional as biologic dressing, it can not only provide ideal temporary wound coverage in extensive burns when autograft is not immediately available but also prepare the wound bed for definitive autografting. In this article, the up-to-date clinical application of allograft in burn care was reviewed, including coverage of extensive burn wounds, combined use with meshed autograft, template for delayed application of cultured epidermal autografts, and the use of human acellular dermal matrix. Although it has potential disadvantages of rejection and disease transmission, allograft skin remains a workhorse in treatment of severe burn wounds.
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Kohlhauser M, Luze H, Nischwitz SP, Kamolz LP. Historical Evolution of Skin Grafting-A Journey through Time. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:348. [PMID: 33916337 PMCID: PMC8066645 DOI: 10.3390/medicina57040348] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/21/2021] [Accepted: 04/02/2021] [Indexed: 01/18/2023]
Abstract
Autologous skin grafting was developed more than 3500 years ago. Several approaches and techniques have been discovered and established in burn care since then. Great achievements were made during the 19th and 20th century. Many of these techniques are still part of the surgical burn care. Today, autologous skin grafting is still considered to be the gold standard for burn wound coverage. The present paper gives an overview about the evolution of skin grafting and its usage in burn care nowadays.
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Affiliation(s)
- Michael Kohlhauser
- COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (H.L.); (S.P.N.); (L.P.K.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Hanna Luze
- COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (H.L.); (S.P.N.); (L.P.K.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Sebastian Philipp Nischwitz
- COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (H.L.); (S.P.N.); (L.P.K.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
| | - Lars Peter Kamolz
- COREMED—Cooperative Centre for Regenerative Medicine, Joanneum Research Forschungsgesellschaft mbH, 8010 Graz, Austria; (H.L.); (S.P.N.); (L.P.K.)
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, 8036 Graz, Austria
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Alharbi S, Niimi Y, Williamson S, Cox R, Williams-Bouyer N, Andersen C, Ouellette C, Enkhbaatar P. Ovine model of burn wounds grafted with ovine cadaver skin. Burns 2021; 48:118-131. [PMID: 33947600 DOI: 10.1016/j.burns.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 02/22/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022]
Abstract
Shortage in autograft to cover burn wounds involves a frequent use of cadaver skin (CS) as a temporary cover to prevent infection, dehydration and preparation of wounds for subsequent autografting. We aimed to establish an ovine model of burn wound healing using ovine CS (OCS). Quality and efficacy of fresh and frozen OCS overlaid on to excised 3rd degree flame burn wounds in sheep were evaluated in comparison to autograft. Histologically, autografted wounds maintained normal skin structure at different time points. Wounds overlaid with fresh OCS graft showed signs of rejection starting from day 7. At day 14, the epidermis was mostly rejected. The rejection was completed by day 20 with signs of immunoreaction and presence of many immune cells. Frozen OCS was rejected in the same pattern. Immediately prior to grafting, the thickness was comparable between freshly prepared and frozen OCS for 10 or 40 days. Significant reduction in viability was detected in OCS frozen for 40 days. Both fresh or frozen ovine OCS were rejected within 10 days that mimics CS rejection time in humans (∼8.4 days), suggesting that ovine model of burn wound grafted with OCS can successfully be used in burn wound research mimicking clinical scenario.
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Affiliation(s)
- Suzan Alharbi
- Department of Neuroscince, Cell Biology and Anatomy, University of Texas Medical Branch, Galveston, TX, USA; Biological Sciences Department, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Yosuke Niimi
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; Department of Plastic and Reconstructive Surgery, Tokyo Women's Medical University, Japan.
| | | | - Robert Cox
- Shriners Hospitals for Children, Galveston, TX, USA; Department of Pathology, University of Texas Medical Branch, Galveston, TX, USA.
| | | | - Clark Andersen
- Office of Biostatistics Statistical Consulting, University of Texas Medical Branch, Galveston, TX, USA.
| | - Casey Ouellette
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Perenlei Enkhbaatar
- Department of Anesthesiology, University of Texas Medical Branch, Galveston, TX, USA; Shriners Hospitals for Children, Galveston, TX, USA.
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Iyun A, Ademola S, Olawoye O, Michael A, Aderibigbe R, Iyun O, Oluwatosin O. Glycerolised skin allografts for extensive burns in low- and middle-income countries. JOURNAL OF WEST AFRICAN COLLEGE OF SURGEONS 2021; 11:35-41. [PMID: 36132972 PMCID: PMC9484497 DOI: 10.4103/jwas.jwas_55_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/07/2022] [Indexed: 11/23/2022]
Abstract
Introduction: There has been a significant improvement in the outcome of treatment of large surface area burns in developed countries. A major contributory factor is an early excision and skin grafting of burn wounds. The initial coverage of large surface area deep burn wounds requires the use of temporary skin substitutes such as allografts due to limited skin autografts. Cadaveric skin allografts are the commonest source of skin allografts in use; however, there may be religious, cultural, cost, or other factors mitigating its availability and routine use in low- and middle-income countries (LMICs). Human skin allografts may be used fresh or stored in tissue banks to ensure its ready availability. The purpose of this review is to promote glycerolised skin allografts as a means of skin preservation in low-resource countries above other modalities cryopreservation due to its cost advantages and relative ease of operation. Materials and Methods: A literature search for articles related to human skin allograft use in burn care, skin banks, and glycerolised skin allografts in LMICs was done using PubMed, EMBASE, and Web of Science databases. The key words used were ‘allograft’ and ‘burn’ with a filter in the search for human studies. The relevant references in the articles obtained were also searched for and included in the review Results: Sixty-three journal articles were reviewed for contents in line with the objectives of this study. Conclusion: Glycerolised skin graft is a viable option for coverage of extensive burns in LMICs.
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Germain N, Hatzfeld AS, Pasquesoone L, Danze PM, Guerreschi P, Sendid B, Gaillot O, Marchetti P. How to improve donor skin availability: Pragmatic procedures to minimize the discard rate of cryopreserved allografts in skin banking. Burns 2020; 47:387-396. [PMID: 32788056 DOI: 10.1016/j.burns.2020.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/28/2020] [Accepted: 07/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Microbial contamination of human skin allografts is a frequent cause of allograft discard. Our purpose was to evaluate the discard rate of skin bank contaminated allografts and specific procedures used to reduce allograft contamination without affecting safety. METHODS We conducted at the Lille Tissue Bank a retrospective study of all deceased donors (n = 104) harvested from January 2018 to December 2018. Skin procurement was split into 3 zones: the back of the body and the two legs that were processed separately. It represented 433 cryopreserved skin allograft pouches of approximatively 500 cm² each. Donors were almost equally split between brain-dead (53%, 55/104) and cadaveric (47%, 49/104) donors. RESULTS Out of all donors, 42 (40.5%) had at least one sampling zone with a positive microbiological test resulting in 106 (24%) contaminated skin pouches. The contamination rate did not vary according to the harvested zone or type of donor. Traumatic deaths showed significantly less contamination rates than other death types (p < 0.05). Contamination rate decreased with time spent in the antibiotic solution. The risk of having contaminated allografts was five-fold higher when the skin spent less than 96 h in the antibiotic cocktail (p < 0.05). According to our validation protocol, most donors (32/42, 76%) had skin allografts contaminated with bacteria (mainly Staphylococcus spp) compatible with clinical use. No recipient infection was recorded as a result of skin graft contaminated with saprophytic or non-pathogenic germs. By harvesting 3 separate zones per donor, the total surface area for clinical use increased by 53% for contaminated donors. Overall, the proportion of contamination-related discarded allografts was 3.2% (14/433 of pouches). CONCLUSION Few simple pragmatic measures (including skin incubation in the antibiotic bath for at least 96 h at 4 °C, splitting the skin harvesting areas to minimize the risk of cross-infection and clinical use of allografts contaminated with saprophytic and non-pathogenic germs) can reduce the discard rate of contaminated allografts without affecting clinical safety.
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Affiliation(s)
- Nicolas Germain
- CHU Lille, Lille Tissue Bank, Biology Pathology Center, F-59000 Lille, France; Univ. Lille, CNRS, Inserm, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France
| | | | - Louise Pasquesoone
- CHU Lille, Department of Plastic Surgery and Burn Care Unit, F-59000 Lille, France
| | - Pierre-Marie Danze
- CHU Lille, Lille Tissue Bank, Biology Pathology Center, F-59000 Lille, France
| | - Pierre Guerreschi
- CHU Lille, Department of Plastic Surgery and Burn Care Unit, F-59000 Lille, France
| | - Boualem Sendid
- CHU Lille, Department of Mycology and Parasitology, Université Lille, LIRIC - Inserm UMR 995- Team 2, F-59000 Lille, Lille, France
| | - Olivier Gaillot
- CHU Lille, Department of Bacteriology, CNRS, INSERM, CHU Lille, U1019-UMR 8204, Center for Infection and Immunity, F-59000 Lille, Lille, France
| | - Philippe Marchetti
- CHU Lille, Lille Tissue Bank, Biology Pathology Center, F-59000 Lille, France; Univ. Lille, CNRS, Inserm, Institut de Recherche contre le Cancer de Lille, UMR9020 - UMR-S 1277 - Canther - Cancer Heterogeneity, Plasticity and Resistance to Therapies, F-59000 Lille, France.
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Awareness and attitude of general population regarding allograft skin donation in Riyadh, Saudi Arabia: Cross-sectional study. Burns 2020; 46:1700-1706. [PMID: 32359970 DOI: 10.1016/j.burns.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 03/24/2020] [Accepted: 04/02/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Burns are one of the major health issues that considerably affect variable groups of the population, varying in age and severity. Despite advances in burn surgical and non-surgical treatments, patient's appearance still represents public health issue. In regards to surgical treatment of burns, skin grafting is still considered the gold standard. One of the major burdens in the burn surgical treatments is the availability of the skin for grafting. As for the non-surgical treatment different modalities of skin dressings or substitutes are still available as an option. METHODS A validated questionnaire based study was utilized to acquire assessment of the overall general population knowledge, awareness and attitude toward skin donation. In addition, it surveyed community personal willingness to donate their skin to a skin bank after being deceased, to help solve skin shortages due to the lack of skin banks in Saudi Arabia. RESULTS A total of 698 individuals completed the questionnaire over the period of 5 months, from February 2018 till June 2018. Married, postgraduate females, with a history of burn in close family members or similar individuals showed a positive attitude toward skin donation. However, 22% of the participants did not agree to donate their skin due to religious reasons. CONCLUSION The study concluded that the majority of participants were willing to donate their skin, and they were aware of the concept of skin donation and its crucial importance in surgical burn management. The current study showed the majority of participants were aware of skin donation and skin use for burn treatment, in addition to having positive attitude toward skin donation. Men were more aware than the women of skin donation. Religious concern was a major reason for participants' skin donation refusal, an issue that can be addressed by contacting Islamic scholars to issue a Fatwa approving the cause.
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Holzer P, Adkins J, Moulton K, Zhu L, Monroy R, Cetrulo CL. Vital, Porcine, Gal-Knockout Skin Transplants Provide Efficacious Temporary Closure of Full-Thickness Wounds: Good Laboratory Practice-Compliant Studies in Nonhuman Primates. J Burn Care Res 2020; 41:229-240. [DOI: 10.1093/jbcr/irz124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AbstractVital, genetically engineered porcine skin transplants have long been regarded as a promising treatment option for severe burn wounds. The objective of this two-part, preclinical study was to evaluate the ability of vital, split-thickness skin xenotransplants derived from designated pathogen-free, alpha 1,3 galactosyltransferase knockout miniature swine to provide temporary wound closure of full-thickness wound defects intended to model severe and extensive, deep partial- and full-thickness burn wounds. In part 1 of the study, four full-thickness wound defects were introduced in four cynomolgus macaques recipients and, then engrafted with two xenografts and two allografts to achieve temporary wound closure. On POD-15, autografts were used to achieve definitive wound closure and were observed until POD-22. In part 2 of the study, four additional subjects each received two full-thickness wound defects, followed by two xenografts to achieve temporary wound closure, and were observed postoperatively for 30 days without further intervention. All grafts were assessed for signs of adherence to the wound bed, vascularity, and signs of immune rejection via gross clinical and histological methods. Xenograft and allograft comparators were equivalent in part 1, and later autografts were otherwise indistinguishable. In part 2, all xenotransplants demonstrated adherence, vascularity, and survival until POD-30. These were unexpected results that exceed previously published findings in similar models. Furthermore, the ensuing GLP-study report directly supported regulatory clearance, permitting a phase I clinical trial. This solution holds great promise as an alternative to human cadaver allograft, the current standard of care for the treatment of severe burns.
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Affiliation(s)
| | - Jon Adkins
- XenoTherapeutics, Grantham, New Hampshire
| | | | | | - Rod Monroy
- XenoTherapeutics, Grantham, New Hampshire
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11
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Simple and efficient method for consecutive inactivation-cryopreservation of porcine skin grafts. J Artif Organs 2019; 23:147-155. [PMID: 31680190 DOI: 10.1007/s10047-019-01142-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
Abstract
We previously reported that inactivation treatment by high hydrostatic pressurization (HHP) has potential utility as a novel skin regeneration therapy for various skin tumors. In this study, we evaluated whether glycerol-cryopreservation could be applied in order to preserve inactivated skin by HHP using a porcine model. Twenty full-thickness skin grafts (1.5 × 1.5 cm) were prepared from a minipig. The skin samples were inactivated by the HHP in normal saline or glycerol/fructose solution, followed by cryopreservation for 5 weeks at - 80 °C in each same solution. Another 10 grafts immediately after inactivation were prepared as non-cryopreserved controls. Nine grafts in each group were randomly implanted on the fascia of a host pig and removed at 1, 4 and 11 weeks after grafting. All grafts showed engraftment macroscopically. Hematoxylin eosin staining showed the cellular components in all areas of the dermis at 4 and 11 weeks after grafting, and immunohistochemical staining for CD31 showed the presence of capillaries in the grafts in all groups. The surface and cross-sectional areas of grafts in the normal saline solution cryopreserved group decreased between 1 and 11 weeks, whereas these areas in the glycerol cryopreserved group did not decrease significantly. Glycerol cryopreservation may therefore be a simple and efficient method for preserving porcine skin inactivated by HHP.
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12
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Regeneration of Dermis: Scarring and Cells Involved. Cells 2019; 8:cells8060607. [PMID: 31216669 PMCID: PMC6627856 DOI: 10.3390/cells8060607] [Citation(s) in RCA: 132] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 12/31/2022] Open
Abstract
There are many studies on certain skin cell specifications and their contribution to wound healing. In this review, we provide an overview of dermal cell heterogeneity and their participation in skin repair, scar formation, and in the composition of skin substitutes. The papillary, reticular, and hair follicle associated fibroblasts differ not only topographically, but also functionally. Human skin has a number of particular characteristics that are different from murine skin. This should be taken into account in experimental procedures. Dermal cells react differently to skin wounding, remodel the extracellular matrix in their own manner, and convert to myofibroblasts to different extents. Recent studies indicate a special role of papillary fibroblasts in the favorable outcome of wound healing and epithelial-mesenchyme interactions. Neofolliculogenesis can substantially reduce scarring. The role of hair follicle mesenchyme cells in skin repair and possible therapeutic applications is discussed. Participation of dermal cell types in wound healing is described, with the addition of possible mechanisms underlying different outcomes in embryonic and adult tissues in the context of cell population characteristics and extracellular matrix composition and properties. Dermal white adipose tissue involvement in wound healing is also overviewed. Characteristics of myofibroblasts and their activity in scar formation is extensively discussed. Cellular mechanisms of scarring and possible ways for its prevention are highlighted. Data on keloid cells are provided with emphasis on their specific characteristics. We also discuss the contribution of tissue tension to the scar formation as well as the criteria and effectiveness of skin substitutes in skin reconstruction. Special attention is given to the properties of skin substitutes in terms of cell composition and the ability to prevent scarring.
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Paggiaro AO, Bastianelli R, Carvalho VF, Isaac C, Gemperli R. Is allograft skin, the gold-standard for burn skin substitute? A systematic literature review and meta-analysis. J Plast Reconstr Aesthet Surg 2019; 72:1245-1253. [PMID: 31176542 DOI: 10.1016/j.bjps.2019.04.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/26/2019] [Accepted: 04/06/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Allograft skin (AS) transplantation has been considered to be the gold standard for replacing tissue damage, following burns. However, increasingly new biosynthetic skin substitutes are being developed as alternatives. The objective of this systematic review is to compare AS with other skin substitutes, which have been used in the treatment of burns. METHODS Randomized clinical trial (RCT) and nonrandomized clinical trial (NRCT) studies comparing AS to any other skin substitute in the treatment of burns were extracted from PubMed/Medline, Scopus, EMBASE, and Web of Science. For the risk of bias analysis, the Cochrane bias risk handbook was used for RCT studies and ROBINS-1 was used for NRCT studies. Outcomes such as healing, self-grafting, scar appearance, and mortality were evaluated. RESULTS Twelve RCT and six NRCT were selected, with most of the methodologies presenting a high risk of bias. Based on the outcomes of the studies, it was not possible to detect any advantages for using AS, as opposed to other skin substitutes. In the meta-analysis, only two outcomes could be evaluated: healing and graft take percentage; however, no significant differences were observed between the groups. CONCLUSION Because of the poor quality of the primary studies, it was not possible to identify differences in the results that compared the use of AS with other substitutes in the treatment of patients with burns. These results support the fact that surgeons primarily base the choice of skin substitute on clinical experience and cost, at least when treating burns.
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Affiliation(s)
- André O Paggiaro
- Nursing Post Graduation, Universidade Guarulhos, 229, Praça Tereza Cristina, Guarulhos, São Paulo 07023-070, Brazil.
| | - Renata Bastianelli
- Nursing Post Graduation, Universidade Guarulhos, 229, Praça Tereza Cristina, Guarulhos, São Paulo 07023-070, Brazil
| | - Viviane F Carvalho
- Nursing Post Graduation, Universidade Guarulhos, 229, Praça Tereza Cristina, Guarulhos, São Paulo 07023-070, Brazil
| | - Cesar Isaac
- Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, 255, Rua Eneas de Carvalho Aguiar, São Paulo 05403-000, Brazil
| | - Rolf Gemperli
- Plastic Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, 255, Rua Eneas de Carvalho Aguiar, São Paulo 05403-000, Brazil
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Anti-IL-6 eluting immunomodulatory biomaterials prolong skin allograft survival. Sci Rep 2019; 9:6535. [PMID: 31024011 PMCID: PMC6484015 DOI: 10.1038/s41598-019-42349-w] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/26/2019] [Indexed: 12/26/2022] Open
Abstract
A primary goal in the management of burn wounds is early wound closure. The use of skin allografts represents a lifesaving strategy for severe burn patients, but their ultimate rejection limits their potential efficacy and utility. IL-6 is a major pleiotropic cytokine which critically links innate and adaptive immune responses. Here, we devised anti-IL-6 receptor eluting gelatin methacryloyl (GelMA) biomaterials (GelMA/anti-IL-6), which were implanted at the interface between the wound beds and skin allografts. Our visible light crosslinked GelMA/anti-IL-6 immunomodulatory biomaterial (IMB) demonstrated a stable kinetic release profile of anti-IL-6. In addition, the incorporation of anti-IL-6 within the GelMA hydrogel had no effect on the mechanical properties of the hydrogels. Using a highly stringent skin transplant model, the GelMA/anti-IL-6 IMB almost doubled the survival of skin allografts. The use of GelMA/anti-IL-6 IMB was far superior to systemic anti-IL-6 receptor treatment in prolonging skin allograft survival. As compared to the untreated control group, skin from the GelMA/anti-IL-6 IMB group contained significantly fewer alloreactive T cells and macrophages. Interestingly, the environmental milieu of the draining lymph nodes (DLNs) of the mice implanted with the GelMA/anti-IL-6 IMB was also considerably less pro-inflammatory. The percentage of CD4+ IFNγ+ cells was much lower in the DLNs of the GelMA/anti-IL-6 IMB group in comparison to the GelMA group. These data highlight the importance of localized immune delivery in prolonging skin allograft survival and its potential utility in treating patients with severe burns.
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Yeo DC, Wiraja C, Paller AS, Mirkin CA, Xu C. Abnormal scar identification with spherical-nucleic-acid technology. Nat Biomed Eng 2019. [PMID: 30936446 DOI: 10.1038/s41551-018-0218-x.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The accurate diagnosis of scar type and severity relies on histopathology of biopsied tissue, which is invasive and time-consuming, causes discomfort and may exacerbate scarring. Here, we show that imaging nanoprobes for the live-cell detection of intracellular messenger RNA (mRNA) (also known as NanoFlares) enable measurements of the expression of connective tissue growth factor (CTGF) as a visual indicator of hypertrophic scars and keloids. During cell culture, NanoFlares enabled the distinction of hypertrophic and keloidal fibroblasts from normal fibroblasts, and the detection of changes in CTGF expression resulting from the regulatory effects of transforming growth factor-β (TGF-β) agonists and TGF-β antagonists. We also applied the NanoFlares topically to the skin of live mice and rabbits, and to ex vivo human skin models. Transepidermal penetration of the NanoFlares enabled the visual and spectroscopic quantification of underlying abnormal fibroblasts on the basis of CTGF mRNA expression. Our proof-of-concept studies of topically applied NanoFlare technology as a means of biopsy-free scar diagnosis may eventually inform therapeutic decisions on the basis of the mRNA-expression patterns of skin disorders.
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Affiliation(s)
- David C Yeo
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Christian Wiraja
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Amy S Paller
- NTU-Northwestern Institute for Nanomedicine, Nanyang Technological University, Singapore, Singapore. .,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Chad A Mirkin
- NTU-Northwestern Institute for Nanomedicine, Nanyang Technological University, Singapore, Singapore. .,Department of Chemistry, Northwestern University, Evanston, IL, USA. .,International Institute for Nanotechnology, Northwestern University, Evanston, IL, USA.
| | - Chenjie Xu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore. .,NTU-Northwestern Institute for Nanomedicine, Nanyang Technological University, Singapore, Singapore.
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16
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High Throughput Screening of Additives Using Factorial Design to Promote Survival of Stored Cultured Epithelial Sheets. Stem Cells Int 2018; 2018:6545876. [PMID: 30581473 PMCID: PMC6276401 DOI: 10.1155/2018/6545876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 08/28/2018] [Accepted: 09/16/2018] [Indexed: 02/03/2023] Open
Abstract
There is a need to optimize storage conditions to preserve cell characteristics during transport of cultured cell sheets from specialized culture units to distant hospitals. In this study, we aimed to explore a method to identify additives that diminish the decrease in the viability of stored undifferentiated epidermal cells using multifactorial design and an automated screening procedure. The cultured cells were stored for 7–11 days at 12°C in media supplemented with various additives. Effects were evaluated by calcein staining of live cells as well as morphology. Twenty-six additives were tested using (1) a two-level factorial design in which 10 additives were added or omitted in 64 different combinations and (2) a mixture design with 5 additives at 5 different concentrations in a total of 64 different mixtures. Automated microscopy and cell counting with Fiji enabled efficient processing of data. Significant regression models were identified by Design-Expert software. A calculated maximum increase of live cells to 37 ± 6% was achieved upon storage of cell sheets for 11 days in the presence of 6% glycerol. The beneficial effect of glycerol was shown for epidermal cell sheets from three different donors in two different storage media and with two different factorial designs. We have thus developed a high throughput screening system enabling robust assessment of live cells and identified glycerol as a beneficial additive that has a positive effect on epidermal cell sheet upon storage at 12°C. We believe this method could be of use in other cell culture optimization strategies where a large number of conditions are compared for their effect on cell viability or other quantifiable dependent variables.
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17
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Keswani SM, Mishra MG, Karnik S, Dutta S, Mishra M, Panda S, Varghese R, Virkar T, Upendran V. Skin banking at a regional burns centre—The way forward. Burns 2018; 44:870-876. [DOI: 10.1016/j.burns.2017.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/09/2017] [Accepted: 11/16/2017] [Indexed: 11/29/2022]
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18
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Histological and mechanical evaluation of antifreeze peptide (Afp1m) cryopreserved skin grafts post transplantation in a rat model. Cryobiology 2018; 82:27-36. [PMID: 29679551 DOI: 10.1016/j.cryobiol.2018.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/27/2018] [Accepted: 04/17/2018] [Indexed: 11/22/2022]
Abstract
The objective of this study was to evaluate the use of Afp1m as a cryopreservative agent for skin by examining the transplanted skin histological architecture and mechanical properties following subzero cryopreservation. Thirty four (34) rats with an average weight of 208 ± 31 g (mean ± SD), were used. Twenty four (n = 24) rats were equally divided into four groups: (i) immediate non-cryopreserved skin autografts (onto same site), (ii) immediate non-cryopreserved skin autografts (onto different sites), (iii) skin autografts cryopreserved with glycerol for 72 h and (iv) skin autografts cryopreserved with Afp1m for 72 h at -4 °C. Rounded shaped full-thickness 1.5-2.5 cm in diameter skin was excised from backs of rats for the autograft transplantation. Non-cryopreserved or cryopreserved auto skin graft were positioned onto the wound defects and stitched. Non-transplanted cryopreserved and non-cryopreserved skin strips from other ten rats (n = 10) were allowed for comparative biomechanical test. All skin grafts were subjected to histological and mechanical examinations at the end of day 21. Histological results revealed that tissue architecture especially the epidermal integrity and dermal-epidermal junction of the Afp1m cryopreserved skin grafts exhibited better histological appearance, good preservation of tissue architecture and structural integrity than glycerolized skin. However, there was no significant difference among these groups in other histological criteria. There were no significant differences among the 4 groups in skin graft mechanical properties namely maximum load. In conclusion, Afp1m were found to be able to preserve the microstructure as well as the viability and function of the skin destined for skin transplantation when was kept at -4 °C for 72 h.
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19
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Yeo DC, Wiraja C, Paller AS, Mirkin CA, Xu C. Abnormal scar identification with spherical-nucleic-acid technology. Nat Biomed Eng 2018; 2:227-238. [PMID: 30936446 DOI: 10.1038/s41551-018-0218-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 03/12/2018] [Indexed: 12/11/2022]
Abstract
The accurate diagnosis of scar type and severity relies on histopathology of biopsied tissue, which is invasive and time-consuming, causes discomfort and may exacerbate scarring. Here, we show that imaging nanoprobes for the live-cell detection of intracellular messenger RNA (mRNA) (also known as NanoFlares) enable measurements of the expression of connective tissue growth factor (CTGF) as a visual indicator of hypertrophic scars and keloids. During cell culture, NanoFlares enabled the distinction of hypertrophic and keloidal fibroblasts from normal fibroblasts, and the detection of changes in CTGF expression resulting from the regulatory effects of transforming growth factor-β (TGF-β) agonists and TGF-β antagonists. We also applied the NanoFlares topically to the skin of live mice and rabbits, and to ex vivo human skin models. Transepidermal penetration of the NanoFlares enabled the visual and spectroscopic quantification of underlying abnormal fibroblasts on the basis of CTGF mRNA expression. Our proof-of-concept studies of topically applied NanoFlare technology as a means of biopsy-free scar diagnosis may eventually inform therapeutic decisions on the basis of the mRNA-expression patterns of skin disorders.
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Affiliation(s)
- David C Yeo
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Christian Wiraja
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore
| | - Amy S Paller
- NTU-Northwestern Institute for Nanomedicine, Nanyang Technological University, Singapore, Singapore. .,Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Chad A Mirkin
- NTU-Northwestern Institute for Nanomedicine, Nanyang Technological University, Singapore, Singapore. .,Department of Chemistry, Northwestern University, Evanston, IL, USA. .,International Institute for Nanotechnology, Northwestern University, Evanston, IL, USA.
| | - Chenjie Xu
- School of Chemical and Biomedical Engineering, Nanyang Technological University, Singapore, Singapore. .,NTU-Northwestern Institute for Nanomedicine, Nanyang Technological University, Singapore, Singapore.
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20
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Oryan A, Alemzadeh E, Moshiri A. Burn wound healing: present concepts, treatment strategies and future directions. J Wound Care 2017; 26:5-19. [DOI: 10.12968/jowc.2017.26.1.5] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- A. Oryan
- Professor, Department of Pathology, School of Veterinary Medicine, Shiraz University, Iran
| | - E. Alemzadeh
- PhD student, Department of Biotechnology, School of Veterinary Medicine, Shiraz University, Iran
| | - A. Moshiri
- Assistant Professor, Division of Regenerative Pharmacology, RAZI Drug Research Centre, Iran University of Medical Sciences, Tehran, Iran; and Division of Surgery and Radiology, Department of Clinical Sciences, School of Veterinary Medicine, Shiraz University, Iran
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21
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Pianigiani E, Tognetti L, Ierardi F, Mariotti G, Rubegni P, Cevenini G, Perotti R, Fimiani M. Assessment of cryopreserved donor skin viability: the experience of the regional tissue bank of Siena. Cell Tissue Bank 2016; 17:241-53. [PMID: 26939692 DOI: 10.1007/s10561-016-9550-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
Skin allografts from cadaver donors are an important resource for treating extensive burns, slow-healing wounds and chronic ulcers. A high level of cell viability of cryopreserved allografts is often required, especially in burn surgery, in Italy. Thus, we aimed to determine which conditions enable procurement of highly viable skin in our Regional Skin Bank of Siena. For this purpose, we assessed cell viability of cryopreserved skin allografts procured between 2011 and 2013 from 127 consecutive skin donors, before and after freezing (at day 15, 180, and 365). For each skin donor, we collected data concerning clinical history (age, sex, smoking, phototype, dyslipidemia, diabetes, cause of death), donation process (multi-tissue or multi-organ) and timing of skin procurement (assessment of intervals such as death-harvesting, harvesting-banking, death-banking). All these variables were analysed in the whole case study (127 donors) and in different groups (e.g. multi-organ donors, non refrigerated multi-tissue donors, refrigerated multi-tissue donors) for correlations with cell viability. Our results indicated that cryopreserved skin allografts with higher cell viability were obtained from female, non smoker, heartbeating donors died of cerebral haemorrhage, and were harvested within 2 h of aortic clamping and banked within 12 h of harvesting (13-14 h from clamping). Age, cause of death and dyslipidaemia or diabetes did not appear to influence cell viability. To maintain acceptable cell viability, our skin bank needs to reduce the time interval between harvesting and banking, especially for refrigerated donors.
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Affiliation(s)
- E Pianigiani
- Dermatology Unit and Skin Bank, Department of Clinical Medicine and Immunological Science, University of Siena, "Le Scotte" Hospital - AOUS, V.le Bracci, 53100, Siena, Italy.
| | - L Tognetti
- Dermatology Unit and Skin Bank, Department of Clinical Medicine and Immunological Science, University of Siena, "Le Scotte" Hospital - AOUS, V.le Bracci, 53100, Siena, Italy
| | - F Ierardi
- Dermatology Unit and Skin Bank, Department of Clinical Medicine and Immunological Science, University of Siena, "Le Scotte" Hospital - AOUS, V.le Bracci, 53100, Siena, Italy
| | - G Mariotti
- Dermatology Unit and Skin Bank, Department of Clinical Medicine and Immunological Science, University of Siena, "Le Scotte" Hospital - AOUS, V.le Bracci, 53100, Siena, Italy
| | - P Rubegni
- Dermatology Unit and Skin Bank, Department of Clinical Medicine and Immunological Science, University of Siena, "Le Scotte" Hospital - AOUS, V.le Bracci, 53100, Siena, Italy
| | - G Cevenini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - R Perotti
- Dermatology Unit and Skin Bank, Department of Clinical Medicine and Immunological Science, University of Siena, "Le Scotte" Hospital - AOUS, V.le Bracci, 53100, Siena, Italy
| | - M Fimiani
- Dermatology Unit and Skin Bank, Department of Clinical Medicine and Immunological Science, University of Siena, "Le Scotte" Hospital - AOUS, V.le Bracci, 53100, Siena, Italy
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22
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Fletcher JL, Cancio LC, Sinha I, Leung KP, Renz EM, Chan RK. Inability to determine tissue health is main indication of allograft use in intermediate extent burns. Burns 2015; 41:1862-1867. [PMID: 26471053 DOI: 10.1016/j.burns.2015.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Cutaneous allograft is commonly used in the early coverage of excised burns when autograft is unavailable. However, allograft is also applied in intermediate-extent burns (25-50%), during cases in which it is possible to autograft. In this population, there is a paucity of data on the indications for allograft use. This study explores the indications for allograft usage in moderate size burns. METHODS Under an IRB-approved protocol, patients admitted to our burn unit between March 2003 and December 2010 were identified through a review of the burn registry. Data on allograft use, total burn surface area, operation performed, operative intent, number of operations, intensive care unit length of stay, and overall length of stay were collected and analyzed. Data are presented as means±standard deviations, except where noted. RESULTS In the study period, 146 patients received allograft during their acute hospitalization. Twenty-five percent of allograft recipients sustained intermediate-extent burns. Patients with intermediate-extent burns received allograft later in their hospitalization than those with large-extent (50-75% TBSA) burns (6.8 days vs. 3.4 days, p=0.01). Allografted patients with intermediate-extent burns underwent more operations (10.8 vs. 6.1, p=0.002) and had longer hospitalizations (78.3 days vs. 40.9 days, p<0.001) than non-allografted patients, when controlled for TBSA. Clinical rationale for placement of allograft in this population included autograft failure, uncertain depth of excision, lack of autograft donor site, and wound complexity. When uncertain depth of excision was the indication, allograft was universally applied onto the face. In half of allografted intermediate-extent burn patients the inability to identify a viable recipient bed was the ultimate reason for allograft use. CONCLUSIONS Unlike large body surface area burns, allograft skin use in intermediate-extent injury occurs later in the hospitalization and is driven by the inability to determine wound bed suitability for autograft application. Allograft application can be utilized to test recipient site viability in cases of autograft failure or uncertain depth of excision.
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Affiliation(s)
- John L Fletcher
- Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States; Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States; Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States
| | - Leopoldo C Cancio
- Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States
| | - Indranil Sinha
- Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, United States
| | - Kai P Leung
- Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States
| | - Evan M Renz
- Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States
| | - Rodney K Chan
- Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States; Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States.
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Martínez-Flores F, Chacón-Gómez M, Madinaveitia-Villanueva JA, Barrera-Lopez A, Aguirre-Cruz L, Querevalu-Murillo W. [The clinical use of cryopreserved human skin allografts for transplantation]. CIR CIR 2015; 83:485-91. [PMID: 26187707 DOI: 10.1016/j.circir.2015.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The biological recovery of human skin allografts is the gold standard for preservation in Skin Banks. However, there is no worldwide consensus about specific allocation criteria for preserved human skin allografts with living cells. A report is presented on the results of 5 years of experience of using human skin allografts in burned patient in the Skin and Tissue Bank at the "Instituto Nacional de Rehabilitacion" MATERIAL AND METHODS The human skin allografts were obtained from multi-organ donors. processed and preserved at -80 °C for 12 months. Allocation criteria were performed according to blood type match, clinical history, and burned body surface. RESULTS Up to now, the Skin and Tissue Bank at 'Instituto Nacional de Rehabilitacion" has processed and recovered 125,000 cm(2) of human skin allografts. It has performed 34 surgical implants on 21 burned patients. The average of burn body surface was 59.2%. More than two-thirds (67.7%) of recipients of skin allografts were matched of the same to type blood of the donor, and 66.6% survived after 126 days hospital stay. CONCLUSION It is proposed to consider recipient's blood group as allocation criteria to assign tissue; and use human skin allografts on patiens affected with burns over 30% of body surface (according the "rule of the 9").
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Affiliation(s)
- Francisco Martínez-Flores
- Banco de Piel y Tejidos, Instituto Nacional de Rehabilitación, Secretaría de Salud, México, D.F., México.
| | - María Chacón-Gómez
- Banco de Piel y Tejidos, Instituto Nacional de Rehabilitación, Secretaría de Salud, México, D.F., México
| | | | - Araceli Barrera-Lopez
- Banco de Piel y Tejidos, Instituto Nacional de Rehabilitación, Secretaría de Salud, México, D.F., México
| | - Lucinda Aguirre-Cruz
- Laboratorio de Neuroinmunoendocrinología, Instituto Nacional de Neurología y Neurocirugía «Manuel Velasco Suarez», Secretaría de Salud, México, D.F., México
| | - Walter Querevalu-Murillo
- Coordinación de Donación de Órganos y Tejidos, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México, D.F., México
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Yoon C, Lim K, Lee S, Choi Y, Choi Y, Lee J. Comparison between cryopreserved and glycerol-preserved allografts in a partial-thickness porcine wound model. Cell Tissue Bank 2015; 17:21-31. [DOI: 10.1007/s10561-015-9521-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
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25
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Clinical application and viability of cryopreserved cadaveric skin allografts in severe burn: A retrospective analysis. Burns 2014; 40:61-6. [DOI: 10.1016/j.burns.2013.05.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Revised: 05/05/2013] [Accepted: 05/07/2013] [Indexed: 12/15/2022]
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26
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Schiozer WA, Gemperli R, Mühlbauer W, Munhoz AM, Ferreira MC. An outcome analysis and long-term viability of cryopreserved cultured epidermal allografts: assessment of the conservation of transplantable human skin allografts. Acta Cir Bras 2013; 28:824-32. [DOI: 10.1590/s0102-86502013001200004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 11/20/2013] [Indexed: 11/22/2022] Open
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