Heather Cleland1, Jason Wasiak2, Hannah Dobson3, Michelle Paul4, George Pratt5, Eldho Paul6, Marisa Herson7, Shiva Akbarzadeh8. 1. Skin Culture Laboratory, Victorian Adult Burns Service and Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: H.Cleland@alfred.org.au. 2. Victorian Adult Burns Service and School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: J.Wasiak@alfred.org.au. 3. Skin Culture laboratory, Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: hannah.dobson@gmail.com. 4. Skin Culture laboratory, Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: M.Paul@alfred.org.au. 5. Skin Culture laboratory, Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: G.Pratt@alfred.org.au. 6. School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: eldho.paul@monash.edu. 7. Donor Tissue Bank of Victoria, 57-83 Kavanagh Street, Southbank, Melbourne, Australia. Electronic address: marisah@vifm.org. 8. Skin Culture Laboratory, Victorian Adult Burns Service and Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: shiva.akbarzadeh@monash.edu.
Abstract
INTRODUCTION: Cadaveric cutaneous allografts are used in burns surgery both as a temporary bio-dressing and occasionally as definitive management of partial thickness burns. Nonetheless, limitations in the understanding of the biology of these grafts have meant that their role in burns surgery continues to be controversial. METHODS: A review of all patients suffering 20% or greater total body surface area (TBSA) burns over an eight year period that received cadaveric allografts were identified. To investigate whether tissue viability plays a role in engraftment success, five samples of cryopreserved cadaveric cutaneous allograft processed at the Donor Tissue Bank of Victoria (DTBV) were submitted to our laboratory for viability analysis using two methods of Trypan Blue Exclusion and tetrazolium salt (MTT) assays. RESULTS: During the study period, 36 patients received cadaveric allograft at our institution. The average total burn surface area (TBSA) for this group of patients was 40% and all patients received cadaveric skin as a temporizing measure prior to definitive grafting. Cadaveric allograft was used in complicated cases such as wound contamination, where synthetic dressings had failed. Viability tests showed fewer than 30% viability in processed allografts when compared to fresh skin following the thawing process. However, the skin structure in the frozen allografts was histologically well preserved. CONCLUSION: Cryopreserved cutaneous cadaveric allograft has a positive and definite role as an adjunct to conventional dressing and grafting where available, particularly in patients with large TBSA burns. The low viability of cryopreserved specimens processed at DTBV suggests that cell viability in cadaveric allograft may not be essential for its clinical function as a wound dressing or even as permanent dermal substitute.
INTRODUCTION: Cadaveric cutaneous allografts are used in burns surgery both as a temporary bio-dressing and occasionally as definitive management of partial thickness burns. Nonetheless, limitations in the understanding of the biology of these grafts have meant that their role in burns surgery continues to be controversial. METHODS: A review of all patients suffering 20% or greater total body surface area (TBSA) burns over an eight year period that received cadaveric allografts were identified. To investigate whether tissue viability plays a role in engraftment success, five samples of cryopreserved cadaveric cutaneous allograft processed at the Donor Tissue Bank of Victoria (DTBV) were submitted to our laboratory for viability analysis using two methods of Trypan Blue Exclusion and tetrazolium salt (MTT) assays. RESULTS: During the study period, 36 patients received cadaveric allograft at our institution. The average total burn surface area (TBSA) for this group of patients was 40% and all patients received cadaveric skin as a temporizing measure prior to definitive grafting. Cadaveric allograft was used in complicated cases such as wound contamination, where synthetic dressings had failed. Viability tests showed fewer than 30% viability in processed allografts when compared to fresh skin following the thawing process. However, the skin structure in the frozen allografts was histologically well preserved. CONCLUSION: Cryopreserved cutaneous cadaveric allograft has a positive and definite role as an adjunct to conventional dressing and grafting where available, particularly in patients with large TBSA burns. The low viability of cryopreserved specimens processed at DTBV suggests that cell viability in cadaveric allograft may not be essential for its clinical function as a wound dressing or even as permanent dermal substitute.
Authors: Paul W Holzer; Alexandre G Lellouch; Krysta Moulton; Laurence Zhu; Zhi Yang Ng; Bo Overschmidt; Amon-Ra Gama; Angelo A Leto Barone; Ivy Rosales; Rod Monroy; Curtis L Cetrulo Journal: J Burn Care Res Date: 2020-02-19 Impact factor: 1.845
Authors: Dominic Henn; Kellen Chen; Tobias Fehlmann; Artem A Trotsyuk; Dharshan Sivaraj; Zeshaan N Maan; Clark A Bonham; Janos A Barrera; Chyna J Mays; Autumn H Greco; Sylvia E Moortgat Illouz; John Qian Lin; Sydney R Steele; Deshka S Foster; Jagannath Padmanabhan; Arash Momeni; Dung Nguyen; Derrick C Wan; Ulrich Kneser; Michael Januszyk; Andreas Keller; Michael T Longaker; Geoffrey C Gurtner Journal: Sci Adv Date: 2021-12-01 Impact factor: 14.136