Skin Allograft and Vascularized Composite Allograft

Abstract

Tissue transplantation restores form and function in burn patients. The treatment of burn injuries is influenced by severity, location, and the percentage of total body surface area. There have been a number of different techniques developed to temporize and repair the destroyed tissue. However, in patients with large wound burden, sufficient donor site tissue may not be available for autograft harvesting. Such extensive burns necessitate other temporary and permanent options for wound coverage such as skin or vascularized composite allografts (VCA). Rejection of these tissues presents an ongoing problem which is currently managed using a host of systemic immunosuppressive medications. This article discusses the mechanism behind the innate and adaptive immune systems rejection of the allografts. By understanding these pathways, various techniques using immunomodulatory protocols have led to increased allograft survival. However, our primary interest lies in the initial recognition of the graft. We tailor this article to have a specific emphasis on lymphatic modulation as a potential adjunctive therapy. Reviews of the studies evaluating the effect of lymph node modulation on graft survival are described with future implications to allograft transplant research.

Reconstructing Severe Lower Extremity Skin Necrosis in a Pediatric Patient

“…In wound reconstruction, split-thickness skin autografts provide optimal viability and tissue development compared with cellular and/or tissue-based products. 8 However, the latter can be used for the maturation and contraction of large wounds to reduce the amount of autograft required for final coverage. 9 In this case patient, TheraSkin was used as a temporizing measure but was also found to reduce the amount of required skin graft by nearly 70%.…”