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Schlottmann F, Strauß S, Ziesing S, Reineke C, Ipaktchi R, Weyand B, Krezdorn N, Vogt PM, Bucan V. Organization of Hannover Skin Bank: Sterile culture and procurement protocols for viable cryopreserved allogeneic skin grafts of living donors. Int Wound J 2024; 21:e14374. [PMID: 37675770 PMCID: PMC10784195 DOI: 10.1111/iwj.14374] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Preserved allogeneic donor skin still represents one of the gold standard therapies in temporary wound coverage in severely burned patients or chronic wounds. Allogeneic skin grafts are currently commercially available as cryo- or glycerol-preserved allografts through skin tissue banks all over the world. Most of the skin tissue banks rely on human cadaveric skin donations. Due to the chronic shortage of human allogeneic transplants, such as skin, and increasing costs in the procurement of allografts from other skin tissue banks, Hannover Medical School has been building up its own skin tissue bank based on allogeneic skin grafts from living donors who underwent surgical treatment (i.e., body-contouring procedures, such as abdominioplasties). This article presents procedures and protocols for the procurement and processing of allogeneic skin grafts according to national legislation and European regulations and guidelines. Beside protocols, initial microbiological data regarding the sterility of the harvested grafts are presented. The results currently form the basis for further investigations as well as clinical applications. In summary, a microbiological testing and acceptance procedure is presented that ensures adequate patient safety and skin viability.
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Affiliation(s)
- Frederik Schlottmann
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Sarah Strauß
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Stefan Ziesing
- Department of MicrobiologyHannover Medical SchoolHannoverGermany
| | | | - Ramin Ipaktchi
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
- Department of Plastic and Hand Surgery, InselspitalUniversity Hospital BernBernSwitzerland
| | - Birgit Weyand
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Nicco Krezdorn
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Peter Maria Vogt
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
| | - Vesna Bucan
- Department of Plastic, Aesthetic, Hand and Reconstructive SurgeryHannover Medical SchoolHannoverGermany
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Radzikowska-Büchner E, Łopuszyńska I, Flieger W, Tobiasz M, Maciejewski R, Flieger J. An Overview of Recent Developments in the Management of Burn Injuries. Int J Mol Sci 2023; 24:16357. [PMID: 38003548 PMCID: PMC10671630 DOI: 10.3390/ijms242216357] [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: 09/25/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
According to the World Health Organization (WHO), around 11 million people suffer from burns every year, and 180,000 die from them. A burn is a condition in which heat, chemical substances, an electrical current or other factors cause tissue damage. Burns mainly affect the skin, but can also affect deeper tissues such as bones or muscles. When burned, the skin loses its main functions, such as protection from the external environment, pathogens, evaporation and heat loss. Depending on the stage of the burn, the patient's condition and the cause of the burn, we need to choose the most appropriate treatment. Personalization and multidisciplinary collaboration are key to the successful management of burn patients. In this comprehensive review, we have collected and discussed the available treatment options, focusing on recent advances in topical treatments, wound cleansing, dressings, skin grafting, nutrition, pain and scar tissue management.
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Affiliation(s)
- Elżbieta Radzikowska-Büchner
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Inga Łopuszyńska
- Department of Plastic, Reconstructive and Maxillary Surgery, National Medical Institute of the Ministry of the Interior and Administration, Wołoska 137 Street, 02-507 Warszawa, Poland;
| | - Wojciech Flieger
- Department of Human Anatomy, Medical University of Lublin, Jaczewskiego 4 Street, 20-090 Lublin, Poland;
| | - Michał Tobiasz
- Department of Plastic Surgery, Reconstructive Surgery and Burn Treatment, Medical University of Lublin, Krasnystawska 52 Street, 21-010 Łęczna, Poland;
| | - Ryszard Maciejewski
- Faculty of Medicine, University of Warsaw, Żwirki i Wigury 101 Street, 02-089 Warszawa, Poland;
| | - Jolanta Flieger
- Department of Analytical Chemistry, Medical University of Lublin, Chodźki 4A Street, 20-093 Lublin, Poland
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Staud CJ, Resch A, Christ A, Borger A, Zaussinger M, Teufelsbauer M, Worel N, Radtke C. Skin Bank Establishment in Treatment of Severe Burn Injuries: Overview and Experience with Skin Allografts at the Vienna Burn Center. J Clin Med 2023; 12:4717. [PMID: 37510832 PMCID: PMC10381394 DOI: 10.3390/jcm12144717] [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: 06/08/2023] [Revised: 07/09/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible for inclusion in this retrospective study. Overall, 202 donor skin grafts obtained from the in-house skin bank were applied in the Department of Plastic and Reconstructive and Aesthetic Surgery, Medical University of Vienna. Between 2017 and 2022, we analysed the results in patient treatment, the selection of skin donors, tissue procurement, tissue processing and storage of allografts, as well as the condition and morphology of the allografts before application. The average Abbreviated Burn Severity Index (ABSI) was 8.5 (range, 5-12), and the mean affected total body surface area (TBSA) was 46.1% (range, 20-80%). In total, allograft application was performed 14 times. In two cases, a total of eight allografts were removed due to local infection, accounting for 3.96% of skin grafts. Six patients survived the acute phase of treatment. Scanning electron microscope images and histology showed no signs of scaffold decomposition and intact tissue layers of the allografts. The skin banking program and the application of skin allografts at the Vienna Burn Center can be considered successful. In severe burn injuries, skin allografts provide time by serving as sufficient wound coverage after early necrosectomy. Having an in-house skin banking program at a dedicated burn centre is particularly advantageous since issues of availability and distribution can be minimized. Skin allografts provide a reliable treatment option in patients with extensive burn injuries.
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Affiliation(s)
- Clement J Staud
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Annika Resch
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Alexandra Christ
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Anton Borger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Maximilian Zaussinger
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Maryana Teufelsbauer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Nina Worel
- Department of Transfusion Medicine and Cell Therapy, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Christine Radtke
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
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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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Roberson JL, Pham J, Shen J, Stewart K, Hoyte-Williams PE, Mehta K, Rai S, Pedraza JM, Allorto N, Pham TN, Stewart BT. Lessons Learned From Implementation and Management of Skin Allograft Banking Programs in Low- and Middle-Income Countries: A Systematic Review. J Burn Care Res 2020; 41:1271-1278. [PMID: 32504535 DOI: 10.1093/jbcr/iraa093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Wound excision and temporary coverage with a biologic dressing can improve survival for patients with large burns. Healthcare systems in low- and middle-income countries (LMICs) rarely have access to allografts, which may contribute to the limited survival of patients with large burns in these settings. Therefore, we aimed to describe the lessons learned from the implementation and maintenance of tissue banks in LMICs to guide system planning and organization. PubMed, MEDLINE, CINAHL, and World Health Organization Catalog were systematically searched with database-specific language to represent a priori terms (eg, skin, allograft, and tissue bank) and all LMICs as defined by the World Bank. Data regarding tissue banking programs were extracted and described in a narrative synthesis. The search returned 3346 records, and 33 reports from 17 countries were analyzed. Commonly reported barriers to ideal or planned implementation included high capital costs and operational costs per graft, insufficient training opportunities, opt-in donation schemes, and sociocultural stigma around donation and transplantation. Many lessons were learned from the implementation and management of tissue banks around the world. The availability of skin allografts can be improved through strategic investments in governance and regulatory structures, international cooperation initiatives, training programs, standardized protocols, and inclusive public awareness campaigns. Furthermore, capacity-building efforts that involve key stakeholders may increase rates of pledges, donations, and transplantations. Some issues were ubiquitously reported and could be addressed by current and future tissue banking programs to ensure allograft availability for patients living in countries of all income levels.
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Affiliation(s)
- Jeffrey L Roberson
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia
| | - Julie Pham
- School of Medicine, University of Washington, Seattle
| | - Jolie Shen
- School of Medicine, University of Washington, Seattle
| | - Kelly Stewart
- School of Medicine, University of Washington, Seattle
| | - Paa Ekow Hoyte-Williams
- Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Reconstructive Plastic Surgery and Burns Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Kajal Mehta
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle.,UW Medicine Regional Burn Center, Seattle, Washington
| | - Shankar Rai
- Nepal Cleft and Burn Center, Kirtipur, Nepal
| | | | - Nikki Allorto
- Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.,Burns Unit, Edendale Hospital, Pietermaritzburg, South Africa
| | - Tam N Pham
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle.,UW Medicine Regional Burn Center, Seattle, Washington
| | - Barclay T Stewart
- Division of Trauma, Burn, and Critical Care Surgery, Department of Surgery, University of Washington, Seattle.,UW Medicine Regional Burn Center, Seattle, Washington.,Harborview Injury Prevention and Research Center, Seattle, Washington
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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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Patil S. Challenges in setting up a skin bank at GMC Nagpur. INDIAN JOURNAL OF BURNS 2019. [DOI: 10.4103/ijb.ijb_29_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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