Use of Skin Allograft in Upper Extremity Deep Burns

Abstract

Introduction: Surgical treatment in patients with deep upper limbs diagnosis consists of elimination of nonvital tissue and coverage of resultant wound. Coverage may be definitive or temporal. One common option of temporal coverage is skin allograft, which represents a biological barrier that promotes reepithelialization and generates a matrix to skin autograft if it is necessary. Our Burn Center uses skin allograft from National Cells, Tissue and Organs Donation and Transplant Institute. This institute is in charge of the obtention from cadavers and the processing of this tissue. Objective: General objective is to describe the type of coverage used in patients with diagnosis of upper limb deep burn. Specific objective are to evaluate adhesion time of skin allograft, the percentage of dermis incorporation, and the number of surgical interventions required to reach total coverage of burn wound. Materials and Methods: We present a descriptive and retrospective study, including 50 patients with deep upper limbs burn who required hospitalization in National Burn Center in the period between December 1, 2014 and December 1, 2015. Results: In that sample, 38 where male (76%) and 12 female (24%), with a mean age of 40 years. Thirty patients (60%) required definitive coverage with skin autograft, while in 15 cases (36%) we used skin allograft. When skin allograft was used, 5 cases registered more than 80% adhesion 3 weeks postoperatory. One of those 5 cases had a 100% adhesion with dermis incorporation and reepitelialization. Four cases had an adhesion of skin allograft between 50% and 80% at 3 weeks postoperatory, and 6 patients registered less than 50% of adhesion at 3 weeks. Three of these 6 last cases had 0% of adhesion at 3 weeks. Conclusions: Skin allograft is a frequent option to burn-wound coverage in upper limb burned areas, acting as a biological and mechanic barrier during 3 weeks in 80% of total cases. That makes local treatment easier because it may be done less frequently representing less mobility for the patient and less sanitary costs. Besides, it reduces the risk of complications of burn wound and generates an appropriate matrix to skin autograft if it is required.