Postal survey on the use of glycerol-preserved allografts in clinical practice

Abstract

Glycerol-preserved allografts (GPAs) are in widespread use throughout Europe in the management of burns injury. However, little is known of the clinical usage and effectiveness of GPA. To gain more insight into clinical practice, The Euro Skin Bank (ESB), which is the main provider of GPA, sent a questionnaire to 62 burn centres which had received GPA from the ESB in the last 5 years. Replies from 37 centres were received, of which 31 contained useful information. Ninety percent of correspondents used GPA regularly, although 24% of centres would prefer to use cryo-preserved allografts and 16% preferred fresh allografts. Three principal indications for GPA were identified: its use as a temporary cover on freshly excised wounds; its use as an overlay on widely expanded autografts and its use to improve the quality of the wound bed prior to autografting. Twenty-five percent of correspondents used GPA as a biological dressing for partial thickness injuries. Pre-operative topical therapy consisted of semi-closed wound treatment with frequent dressing changes and application of silver sulfadiazine (SSD) or SSD with 1% cerium nitrate. Twenty percent of correspondents also used povidone iodine. The surgical approach of early excision and wound coverage (autograft or allograft) were followed by all correspondents. Graft fixation was achieved by staples alone or in combination with fibrin glue or adhesive dressings. Post-operative care comprised frequent dressing changes. Few clinicians used topical antibacterial agents and peri-operative antibiotics were prescribed by a third of correspondents. Few complications were reported following GPA use. Around 50% of clinicians reported “occasional” wound infection; around 50% of clinicians reported “occasional” graft failure. In general, GPA appeared to perform well in clinical practice.