Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2016, vol. 25, nr 5, September-October, p. 923–929

doi: 10.17219/acem/61961

Publication type: original article

Language: English

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching

Diana Kitala1,A,B,C,D, Marek Kawecki1,2,A,C,E,F, Agnieszka Klama-Baryła1,B,D,E, Wojciech Łabuś1,A,D, Małgorzata Kraut1,A,B, Justyna Glik1,3,E,F, Ireneusz Ryszkiel4,E,F, Marek P. Kawecki5,E,F, Mariusz Nowak1,E,F

1 Dr Stanisław Sakiel Centre for Burns Treatment, Siemianowice Śląskie, Poland

2 Medical Rescue Institue of the Nursing and Medical Rescue Department, Faculty of Health Sciences, University of Bielsko-Biała, Poland

3 School of Health Sciences, Department of Nursing, Institute of Chronic Wound Treatment Organisation, Medical University of Silesia in Katowice, Poland

4 Deparment for Health Care Supervision, Katowice, Poland

5 Pharmaceutical Product Development PPD sp. z.o.o., Warszawa, Poland

Abstract

Background. Early application of autologous skin may lead to the loss of split thickness skin graft due to unclarified wound bed. Allogeneic skin grafts are performed on patients with extensive burn injuries after escharotomy, tangential excisions and deep debridement for the purpose of stabilizing the general condition and reducing the scope of local complications.
Objectives. The aim of this paper is to determine how the use of allografts improves the conditions for the intake of autografts in burns treatment, and how it accelerates wound healing in comparison to the autografts-only option.
Material and Methods. In 2012–2013, allogeneic skin was grafted on 46 patients, and in 8 cases grafting was repeated several times. An autologous split-thickness skin graft was applied to 32 patients. The analysis included the relationship between the duration of hospitalization and the number of skin transplantations, the relationship between the time of admission to debridement of the necrotic tissues and the total duration of hospitalization. Statistical analysis encompassed also pain assessment.
Results. The results suggest that multiple applications of autografts not only do not lead to quicker recovery, but even lengthen the hospitalization time. The dependency is visible also in the patients who underwent the skin grafting procedure in allogeneic and autologous systems twice or more. There was a statistical significant difference between the duration of hospitalization in groups of patients who underwent STSG preceded by allogeneic skin graft transplantation when compared to the group of patients who underwent allogeneic skin application (p < 0.05) and the group of patients who were grafted with autologous skin (p < 0.05).
Conclusion. Allogeneic skin grafts are a perfect dressing when wound vascularization is insufficient to take free split-thickness skin graft. In patients with comparable burn surface areas, multiple applications of free autologous split-thickness skin grafts (STSG) extend the hospitalization time in comparison to application of allogeneic skin dressing as the first-line therapy.

Key words

pain, hospitalization, skin graft, burns

References (24)

  1. Kawecki M, Hoff-Lenczewska D, Klama-Baryła A, Glik J, Łabuś W, Nowak M: [Burns]. Adam Dziki, Warszawa 2012, 20th ed., 185–196.
  2. Spanholtz TA, Theodorou P, Amini P, Spilker G: Severe Burn Injuries. Dtsch Arztebl Int 2009, 106, 607–613.
  3. Saad ZM, Khoo TL, Dorai AA, Halim AS: The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction. Indian J Plast Surg 2009, 42, 94–99.
  4. Sorg H, Betzler C, Rennekampff HO, Vogt PM: Burns. Unfallchirurg 2012, 115, 635–648.
  5. Coruh A, Yontar Y: Application of split-thickness dermal grafts in deep partialand full-thickness burns: A new source of auto-skin grafting. J Burn Care Res 2012, 33, 94–100.
  6. Church D, Elsayed S, Reid O, Winston B, Lindsay R: Burn wound infections. Clin Microbiol Rev 2006, 19, 403–434.
  7. Klama-Baryła A, Glik J, Kawecki M, Nowak M, Sieroń AL: Skin substitutes – the application of tissue engineering in burn treatment Part 1. JOTSRR 2008, 11, 96–103.
  8. Klama-Baryła A, Kraut M, Łabuś W, Maj M, Kawecki M, Nowak M, Glik J, Cichowski A, Szydło A, Lesiak M. Anioł J, Sieroń AL: Application of platelet leukocyte gel in in vitro cultured autologous keratinocite grafts. JOTSRR 2011, 2, 77–86.
  9. Murphy PS, Evans GR: Advances in wound healing: A review of current wound healing products. Plast Surg Int 2012, 190436. DOI: 10.1155/2012/190436.
  10. Kagan RJ, Robb EC, Plessinger RT: Human Skin Banking. Clin Lab Med 2005, 25, 587–605.
  11. Tiwari VK: Burn wound: How it differs from other wounds? Indian J Plast Surg 2012, 45, 364–373.
  12. Chen B, Hu DH, Jia CY, Ding GB, Yao QJ, Liu YL: Management of a patient with massive and deep burns: Early care and reconstruction after convalescence. Zhonghua Shao Shang Za Zhi 2007, 23, 112–116.
  13. Domres B, Kistler D, Rutczynska J: Intermingled skin grafting: A valid transplantation method at low cost. Ann Burns Fire Disasters 2007, 20, 149–154.
  14. Shevchenko RV, James SL, James SE: A review of tissue-engineered skin bioconstructs available for skin reconstruction. J R Soc Interface 2010, 7, 229–258.
  15. Harvey C: Wound healing. Orthop Nurs 2005, 24, 143–157.
  16. Boerner E, Bauer J, Ratajczak B, Dereń E, Podbielska H: Application of thermovision for analysis of superficial temperature distribution changes after physiotherapy. J Thermal Analys & Calorim 2015, 120, 261–267.
  17. Majchrzak E, Mochnacki B, Dziewoński M, Jasiński M: Numerical modelling of hyperthermia and hypothermia processes. Adv Mat Res 2011, 257–262.
  18. Lloyd EC, Michener M, Williams MS: Outpatient burns: Prevention and care. Am Fam Physician 2012, 85, 25–32.
  19. Feng G, Nadig SN, Bäckdahl L, Beck S, Francis RS, Schiopu A, Whatcott A, Wood KJ, Bushell A: Functional regulatory T cells produced by inhibiting cyclic nucleotide phosphodiesterase type 3 prevent allograft rejection. Sci Transl Med 2011, 3: 83ra4.
  20. Benichou G, Yamada Y, Yun SH, Lin C, Fray M, Tocco G: Immune recognition and rejection of allogeneic skin grafts. Immunotherapy 2011, 3, 757–770.
  21. Unal S, Ersoz G, Demirkan F, Arslan E, Tütüncü N, Sari A: Analysis of skin-graft loss due to infection: Infectionrelated graft loss. Ann Plast Surg 2005, 55, 102–106.
  22. Brusselaers N, Monstrey S, Vogelaers D, Hoste E, Blot S: Severe burn injury in Europe: A systematic review of the incidence, etiology, morbidity, and mortality. Crit Care 2010, 14, R1 88.
  23. Bahar MA, Nabai L, Ghahary A: Immunoprotective role of indoleamine 2,3-dioxygenase in engraftment of allogenic skin substitute in wound healing. J Burn Care Re 2012, 33, 94–100.
  24. Izadi K, Ganchi P: Chronic wounds. Clin Plast Surg 2005, 32, 209–222.