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.

An Overview of Recent Developments in the Management of Burn Injuries

“…For patients with a significant percentage of their TBSA damaged, a skin autograft is not possible. In this case, the solution is to temporarily cover the wounds with skin allografts [237,238]. It is believed that allogeneic skin is an excellent but temporary biologic dressing that is discarded within 1-2 weeks or has to be removed because of infection.…”

“…Skin banks, where skin can be stored in frozen liquid nitrogen for up to five years, have been established in many countries to provide a supply of skin allografts [240]. Recently, a team from the Department of Plastic, Reconstructive and Aesthetic Surgery at the Medical University of Vienna described their experience with the skin bank program [237].…”