The Use of Non-viable Glycerol-preserved Cadaver Skin Combined with Widely Expanded Autografts in the Treatment of Extensive Third-degree Burns

Kreis, R.W.; Vloemans, A.F.P.M.; Hoekstra, M.J.; Mackie, David; Hermans, R.P.

doi:10.1097/00005373-198901000-00010

Cited by 99 publications

(27 citation statements)

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“…Full-thickness skin defects (225 mm 2 ) were created on the dorsum of rats (n ϭ 29), porcine or rat ADMs were implanted in them, and these were overlain with ultrathin split-thickness skin grafts (STSGs). In two adjacent wounds, 0.005-or 0.017-inch-thick autografts were implanted.…”

Section: Methodsmentioning

confidence: 99%

Use of Porcine Acellular Dermal Matrix as a Dermal Substitute in Rats

Srivastava¹,

DeSagun²,

Jennings³

et al. 2001

Annals of Surgery

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ObjectiveTo examine porcine acellular dermal matrix (ADM) as a xenogenic dermal substitute in a rat model. Summary Background DataAcellular dermal matrix has been used in the treatment of fullthickness skin injuries as an allogenic dermal substitute providing a stable wound base in human and animal studies. MethodsXenogenic and allogenic ADMs were produced by treating porcine or rat skin with Dispase and Triton X-100. Full-thickness skin defects (225 mm 2 ) were created on the dorsum of rats (n ϭ 29), porcine or rat ADMs were implanted in them, and these were overlain with ultrathin split-thickness skin grafts (STSGs). In two adjacent wounds, 0.005-or 0.017-inch-thick autografts were implanted. In other experiments, the antimicrobial agent used during ADM processing (azide or a mixture of antibiotics) and the orientation of the implanted ADM (papillary or reticular side of ADM facing the STSG) were studied. Grafts were evaluated grossly and histologically for 30 days after surgery. ResultsSignificant wound contraction was seen at 14, 20, and 30 days after surgery in wounds receiving xenogenic ADM, allogenic ADM, and thin STSGs. Contraction of wounds containing xenogenic ADM was significantly greater than that of wounds containing allogenic ADM at 30 days after surgery. Graft take was poor in wounds containing xenogenic ADM and moderately good in those containing allogenic ADM. Wound healing was not significantly affected by the antimicrobial agent used during ADM preparation or by the ADM orientation. ConclusionDispase-Triton-treated allogenic ADM was useful as a dermal substitute in full-thickness skin defects, but healing with xenogenic ADM was poor.In extensive deep burns and other full-thickness skin wounds, permanent replacement of lost skin remains a major challenge. Several methods of wound closure are in use, and each has its own advantages and disadvantages. Porcine skin and preserved cadaver skin are used for temporary wound coverage, but 1 to 2 weeks after grafting, these tissues undergo immune-mediated rejection.1,2 Permanent wound coverage is usually accomplished using meshed, split-thickness autografts harvested from undamaged regions of skin. Extensively burned patients have limited donor sites, so thin split-thickness autografts are harvested repeatedly from the same sites. This results in substantial donor-site problems resulting from pain, infection, scarring, and sometimes keloid formation.3 Very thin (0.005-inchthick) meshed autografts can be used, but the lack of a sufficient dermal bed often results in extensive wound contraction at the recipient site. 4 The harvest of thicker splitthickness skin grafts (STSGs) reduces this contraction problem but causes increased problems at donor sites. Alternatively, cultured epidermal autografts expanded using cell culture methods can be used for wound coverage, but this technique is expensive, and cultured epidermal autografts often fail to survive or result in poor-quality wound healing.5-8 Many of these difficulties with STSGs and cul-

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Section: Methodsmentioning

confidence: 99%

Use of Porcine Acellular Dermal Matrix as a Dermal Substitute in Rats

Srivastava¹,

DeSagun²,

Jennings³

et al. 2001

Annals of Surgery

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“…This process could hardly be controlled by currently available immunosuppressive agents (Gardner 1995). To date, allogeneic skin grafts serve mainly as temporary biological wound dressings that provide a suitable environment for the survival and expansion of autologous small patch or micro skin grafts (Kreis et al 1989). In the clinic, autologous skin transplantation is the only viable means of achieving permanent closure of massive wounds and the restoration of skin function.…”

Section: Introductionmentioning

confidence: 99%

Fundamental Immunology of Skin Transplantation and Key Strategies for Tolerance Induction

Zhou

Wang

Luo

et al. 2013

Arch. Immunol. Ther. Exp.

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Transplantation of allogeneic or xenogeneic skin grafts can evoke strong immune responses that lead to acute rejection of the graft tissues. In this process, donor-derived dendritic cells play crucial roles in the triggering of such immune responses. Both the innate and acquired host immune systems participate in graft rejection. At present, the rejection of skin grafts cannot be well-controlled by ordinary systemic immunosuppression therapy. Although several strategies for the long-term survival of allogeneic or xenogeneic skin grafts have been demonstrated in animal models, the induction of long-term tolerance to skin grafts is still a great challenge in clinical settings. In this article, we review the progress in the understanding of immune responses to skin grafts and discuss the possible methods that can decrease the immunogenicity of graft tissues and improve the survival of skin grafts, especially those included in preoperative pre-treatments.

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“…Early thrombosis, intimal hyperplasia and aneurysmal degeneration have hampered optimal performance. Glycerol (GL) preservation of skin allografts is successfully used in the management of burn injuries [6,7,8,9]. GL, a non-toxic intermediate of the fatty acid metabolism, leaves the structural integrity of the skin unaffected.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Preserved Vascular Allografts Using Glycerol and University of Wisconsin Solution in a Goat Carotid Artery Transplantation Model

Fahner

Legemate

Wal³

et al. 2011

Eur Surg Res

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Background: Prosthetic grafts have poor patency rates in peripheral arterial reconstructions. Glycerol (GL)-preserved grafts are an alternative. The aim of this study was to examine patency, graft morphology and function of GL-preserved allografts in a goat carotid artery animal model. Methods: The first group (n = 7) underwent bilateral replacement of the carotid artery by a carotid allograft that was preserved in GL for 1 week. In the second group (n = 5), a carotid artery allograft that was preserved in University of Wisconsin solution (UW) for 48 h was used. In the third group (n = 5), the jugular vein (autologous vein, AU) was used. The follow-up was 3 months. Results: One UW graft and 1 GL graft occluded in the first 24 h postoperatively. Three-month primary patency rates for GL, UW and AU grafts were 93, 100 and 80%, respectively (p = 0.39). Graft diameter was increased in UW allografts (p < 0.005), whereas GL allografts remained unchanged. After explantation, GL allografts demonstrated contraction and relaxation capacity and lower intimal thickness (p < 0.001). Conclusion: GL preservation has proven to be a feasible method for arterial allograft transplantation in a large animal model with decreased intimal hyperplasia and renewed functional capability.

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The Use of Non-viable Glycerol-preserved Cadaver Skin Combined with Widely Expanded Autografts in the Treatment of Extensive Third-degree Burns

Cited by 99 publications

References 0 publications

Use of Porcine Acellular Dermal Matrix as a Dermal Substitute in Rats

Use of Porcine Acellular Dermal Matrix as a Dermal Substitute in Rats

Fundamental Immunology of Skin Transplantation and Key Strategies for Tolerance Induction

Comparison of Preserved Vascular Allografts Using Glycerol and University of Wisconsin Solution in a Goat Carotid Artery Transplantation Model

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