Skin Bank Establishment in Treatment of Severe Burn Injuries: Overview and Experience with Skin Allografts at the Vienna Burn Center

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.

Keywords: burn wound; skin allograft; skin bank; skin regeneration; skin substitute.

Figure 1

Sterile storage pots and bags for the transportation of skin allografts to the tissue establishment. The allografts are procured in the operating room and then labelled adequately to ensure traceability.

Figure 2

A skin allograft (thickness between 0.4 and 0.6 mm) in processing at the tissue establishment after removing the antiseptic povidone–iodine solution by washing it in saline twice.

Figure 3

Grade III burn injury during the admission process to our burn unit. The patient suffered from a domestic fire, the injuries affected about 70% of TBSA, and the ABSI was 11. After cardiorespiratory stabilization, the burn wounds were cleaned of loose debris. As a next step, the wounds were treated with antiseptic solution before the bandaging was applied.

Figure 4

Severe grade III burns of the upper body after early necrosectomy was performed. The wounds are covered with skin allografts. On day eight after surgery, the grafts were in place and served as wound coverage. There were no clinical signs of infection. Smears at the time were negative.

Figure 5

Grade III burn injury of the left upper extremity. (a)—Five days after necrosectomy and covered by meshed allograft skin (both hands were covered with unmeshed autograft). (b)—Three weeks after removal of the allograft and replacement by autografts.

Figure 6

(a–c) Five months after skin autograft transplantation. The patient still had to wear compression garments. There were only a few skin lesions left.

Figure 7

(a,b) Skin allografts on scanning electron microscopy. Profound views of the graft at 177× and 1000× magnification. There are no signs of scaffold decomposition after processing and preparation.

Figure 8

(a,b) Skin allografts on scanning electron microscopy. The epidermal view of the graft at 209× and 1000× magnification displays undisturbed continuity of the tissue.

Figure 9

Histological section of an allograft stained with haematoxylin and eosin. The picture shows intact layers of epidermal tissue.