Extensive Burn Injury Research Articles

Raoultella planticola bacteremia-induced fatal septic shock following burn injury

BackgroundRaoultella planticola, a Gram-negative, aerobic bacillus commonly isolated from soil and water, rarely causes invasive infections in humans. Septic shock from R. planticola after burn injury has not been previously reported.Case presentationA 79-year-old male was admitted to the emergency intensive care unit after extensive flame burn injury. He accidently caught fire while burning trash and plunged into a nearby tank filled with contaminated rainwater to extinguish the fire. The patient developed septic shock on day 10. The blood culture detected R. planticola, which was identified using the VITEK-2 biochemical identification system. Although appropriate antibiotic treatment was continued, the patient died on day 12.ConclusionsClinicians should be aware of fatal infections in patients with burn injury complicated by exposure to contaminated water.

348 A Prospective Evaluation of Spray Keratinocytes to Treat Large TBSA Injuries

Over the last two decades, a decrease in mortality rates of burn patients can be attributed to continued advancements in burn resuscitation, intensive care, trauma care and nutritional support and early excision and coverage of the burn wound. However, patients with burns >50% TBSA continue to pose specific challenges to the burn surgeon with regards to autologus coverage due to their lack of donor sites. In September of 2016, we changed our practice with large TBSA burns by incorporating the use of spray keratinocytes (SK) over widely meshed autografts in conjunction with CEA to accelerate wound coverage. This study describes our experience using spray keratinocytes in this patient population. This is an on-going IRB approved prospective uncontrolled observational study evaluating clinical outcomes following the use of SK as an adjunct for closure in the treatment of life-threatening burn wounds, in patients who lack adequate available skin to harvest for conventional grafting. Following surgical excision and wound bed preparation through application of homograft, SK was used in combination with widely meshed STSGs, with a minimum ratio of 3:1, as well as for the treatment of donor sites. Data concerning clinical outcomes was collected through to the time of healing of all SK treated sites with 1 year follow-up. All adverse events associated with the use of SK were documented. Seven patients ranging from 3.9 to 61.8 years of age were treated with SK, with five subjects being less than 14 years old. Total body surface areas ranged from 43% to 95% with a mean of 60%. Collectively, 33 treatment sites and 15 donor sites were treated with SK, with a mean area of 2425.0 cm2 and 325.0 cm2, respectively. As part of the complete treatment regimen for these severely injured patients, four of seven also received CEA. Healing data at 4 weeks post-SK treatment was available for 31 of the 33 treatment sites and indicates that 93.5% of the wounds treated had ≥95% re-epithelialization. Two sites required additional treatment and the only adverse events reported were related to graft loss. Evaluation of donor site healing indicated that by week 1, 86.7% achieved ≥95% re-epithelialization, with two sites having 80% re-epithelialization. By 2 weeks post-treatment, both of these donor sites achieved closure. The use of SK has been successfully used as an adjunct to achieve earlier definitive wound closure for patients with extensive burn injuries allowing for a potentially decrease length of stay, decrease incidence of complication related to prolonged open wounds, and an earlier return to a homeostatic state. SK should be considered for use as part of a surgeon’s treatment algorithm for large TBSA injuries as it allows for greater wound coverage with less donor site.

229 Enteral Fluid Resuscitation Alters Splenic Function and Leukocyte Populations Post-Burn in Swine

Extensive burn injury (>30% total body surface area [TBSA]) leads to significant inflammation and associated organ damage. The spleen is a major reservoir of lymphocytes which decrease systemically post-burn. Abnormal splenic function may relate to the inflammatory response after burn. While intravenous (IV) fluid resuscitation is the current standard for burn care, enteral resuscitation has also shown promise, and may be leveraged to help splenic recovery. However, the effect of resuscitation on the spleen post-burn is largely unstudied. Thirty anesthetized Yorkshire swine subjected to 40% TBSA contact burns were randomized to one of five groups (n=6/group); no fluids, ad lib water, volume-matched Oral Rehydration Salts (ORS) from the World Health Organization, limited-volume (15mL/kg/d) ORS, or IV lactated Ringer’s solution at 2mL/kg/%TBSA/d (IV). Computerized tomography (CT) scans were performed before and 48 h post-burn, at which point spleens were harvested. Histology was performed to localize splenic CD3 and measure the proportion of red and white pulp. Gene and protein expression was analyzed via qPCR, Western blot, and multiplex. The splenic artery diameter was maintained with water (-0.2 ± 0.32mm), limited-volume (0.36 ± 0.37mm), or volume-matched ORS (-0.2 ± 0.04mm), while no fluids led to a reduction (-0.97 ± 0.14mm) and IV fluids led to dilation (0.68 ± 0.30mm) 48 h post-burn. However, no differences in spleen wet-to-dry ratios were detected among treatments. Levels of white pulp were highest in the ad lib water group (233.0 ± 1.7AU), volume-matched ORS (229.7 ± 2.5), and IV groups (233.3 ± 1.363) compared to no fluids (221.9 ± 5.2) or low-volume ORS (218.7 ± 3.4). Gene expression of complement C5 and uteroglobin-related protein 2 were upregulated in IV animals by 2.76 and 2.43 fold, respectively, when compared to volume matched ORS. Protein expression of CD3 tended to be greatest in animals receiving ORS, and IV fluids. Protein levels of IL1ra were greatest in low and volume matched ORS compared to other groups. Burn injury leads to significant changes in splenic leukocytes, which can be altered with different resuscitation strategies. Specifically, access to enteral fluids preserves splenic lymphocytes post-burn similarly to IV fluids, and may uniquely alter the inflammatory response. Enteral fluids also maintain splenic perfusion, with minimal change in splenic artery diameter. The therapeutic efficacy of enteral resuscitation in burn injury warrants further investigation. Enteral fluids represent a viable means of maintaining splenic perfusion which could easily be used to buy time in mass casualty and prolonged field care scenarios in patients with no concomitant abdominal injuries.

117 Minimal Scarring after Grafting a Novel Autologous Self-assembly Skin Substitute on Burn Patients

One of the main complications for patients surviving major burn injuries are contractures and hypertrophic scars. Since the dermis is responsible for the mechanical properties of the skin, we have designed a skin substitute comprising a dermis in addition to an epidermis and evaluated this autologous self-assembly skin substitute (SASS), produced by a tissue engineering approach. The dermis comprised fibroblasts secreting an endogenous extracellular matrix, without any exogenous scaffold. Patients were recruited through Health Canada’s Special Access Program, which allowed extensive burn injuries to be acutely treated with SASSs. The SASSs were grafted on debrided full-thickness wounds according to the same protocol used for autografts. The graft take and the persistence of the SASS’s epithelium overtime were evaluated. Comparative assessment of scar quality for the SASSs, autographs (AGs) and uninjured skin using the Cutometer®, Mexameter® and DermaScan C® devices were performed on a subset of patients. SASS was used as autologous grafts of 14 severely burned patients for deep-partial thickness and full thickness burn wound coverage. The mean of the total surface area grafted was 2,321 cm2 [range 420–6 925]. The median follow-up is 2.3 years [range 1 month-8 years]. One week after grafting, on average 98% [range 85–100%] graft take was obtained. No significant contraction was observed in vivo. SASSs promoted a particularly good healing process and ensuing suppleness. Minimal hypertrophic scars were only observed between the SASSs. The integrity of the transplanted SASSs persisted over time with no defect in epidermal regeneration and no significant contractures. The SASSs were not as pigmented as normal skin, despite some concentrated pigmentation spots that can increase in number and area with time depending on the pateint’s Fitzpatrick skin phototype. Sites grafted with SASSs were comparable to adjacent split-thickness AGs and uninjured skin regarding erythema (SASS site: 292.6 ± 88.5U vs AG: 315.75 ± 61.22U vs. uninjured skin: 258.8 ± 21.5U; p>0.05; N=4 to 8), elasticity (SASS site: 0.87 ± 0.40mm vs AG: 0.90 ± 0.37mm vs. uninjured skin: 1.31 ± 0.72 mm; p>0.05), skin thickness (SASS site: 1.68 ± 0.64mm vs. AG: 1.85 ± 0.45mm vs. uninjured skin: 1.85 ± 0.45 mm; p>0.05) and microscopic features. After grafting, the SASS has very good functional characteristics: minimal contraction and hypertrophic scar as well as long-term durability and tissue regeneration. The SASS is a promising skin substitute for grafting full-thickness skin injuries.

A quality improvement project incorporating preoperative warming to prevent perioperative hypothermia in major burns

BackgroundPatients with extensive burn injuries are susceptible to a host of accompanying adverse effects should they develop perioperative hypothermia, which occurs in up to ¼ of all major burn cases. This quality improvement project aimed to reduce the incidence of perioperative hypothermia to below 10% of cases in patients with major burn (Total Body Surface Area [TBSA] >15%), within a one year period. MethodsA baseline diagnostic phase was undertaken to provide a greater understanding of the incidence, natural history and risk factors of perioperative hypothermia. We also reviewed and reinforced intraoperative measures in current use, including preemptive adjustment of the ambient temperature, underbody warming mattress use, warming blanket application over areas not operated, regular temperature monitoring, and discussion at the WHO surgical checklist. Preoperative forced air warming with a ‘Bair Hugger’™ was identified as a sound change initiative, a strategy applied to good effect in other surgical settings. The primary outcome measure was the percentage of cases of perioperative hypothermia (<36°C), utilizing a time series design for the period between 1 November 2016 and 31 October 2017. Results53 patients with burn greater than 15% TBSA were admitted over the one year period. Of these, 40 patients required 127 operative procedures. Their mean age was 48.23 years, their mean TBSA was 27.65% (range 15–75%), and their mean length of hospital stay was 31.2 days. After the introduction of pre-warming, the proportion of cases of inadvertent hypothermia reduced to 13.77% (n=14/102), with special cause variation, from 24% (n=6/25) in the baseline data collection period. The final temperature correlated with the lowest temperature recorded in only 32% of cases. Based on stakeholder feedback and consensus from the literature, an algorithm was developed which forms the basis for a medical directive for preoperative warming for eligible patients. No significant balancing measures were identified, nor any undue costs incurred. DiscussionThe inevitable drop in temperature is ameliorated by sound perioperative practices, rather than just intraoperative ones. This initiative demonstrated the potential benefits of, and motivates for, the broad application of preoperative warming in the context of major acute burn surgery. Further investigations include PDSA cycles to determine whether the duration or degree of intraoperative hypothermia is more virulent. To consolidate the pre-warming initiative, we have introduced a standard order within our admission order sets to include preoperative warming for all eligible patients.

Management of acute pain in extensive burn injury

Management of acute pain in extensive burn injury

Stem cells, niches and scaffolds: Applications to burns and wound care.

The importance of skin to survival, and the devastating physical and psychological consequences of scarring following reparative healing of extensive or difficult to heal human wounds, cannot be disputed. We discuss the significant challenges faced by patients and healthcare providers alike in treating these wounds. New state of the art technologies have provided remarkable insights into the role of skin stem and progenitor cells and their niches in maintaining skin homeostasis and in reparative wound healing. Based on this knowledge, we examine different approaches to repair extensive burn injury and chronic wounds, including full and split thickness skin grafts, temporising matrices and scaffolds, and composite cultured skin products. Notable developments include next generation skin substitutes to replace split thickness skin autografts and next generation gene editing coupled with cell therapies to treat genodermatoses. Further refinements are predicted with the advent of bioprinting technologies, and newly defined biomaterials and autologous cell sources that can be engineered to more accurately replicate human skin architecture, function and cosmesis. These advances will undoubtedly improve quality of life for patients with extensive burns and difficult to heal wounds.

Accelerated epithelialization and improved wound healing metrics in porcine full-thickness wounds transplanted with full-thickness skin micrografts.

Split-thickness skin grafting (STSG) is the current gold standard for treatment of extensive burn and traumatic skin injuries. However, STSG is limited by donor-site morbidity and availability, and often leads to scarring and wound contracture. Furthermore, these thin grafts lack dermal elements such as nerves and adnexa which are important in recapitulating normal skin function. Methods of fractional skin replacement either as minced STSGs or microscopic skin tissue columns have been proposed, though these techniques have not been fully characterized and lack evidence of regenerated adnexal structures. Here, we describe an alternative method of fractional skin replacement using full-thickness skin micrografts containing deep dermal components and intact adnexa. Full-thickness wounds measuring 3 cm in diameter and 2 cm apart were created on adult female Yorkshire swine. Full-thickness skin tissue columns (FTSTCs) 1.5 mm in diameter with intact adnexa and subcutaneous tissue were obtained using a suction-assisted device. Explant culture was initiated to demonstrate the capacity of FTSTCs to act as reservoirs of viable and proliferative epidermal and dermal cells. FTSTCs were applied directly to excisional wounds at three different expansion ratios (1:16, 1:40, 1:100) in fibrin sealant. Biopsies were collected at defined time points postwounding and processed for histology and immunohistochemistry. Wounds grafted with FTSTCs showed enhanced reepithelialization and epidermal differentiation over untreated control wounds in a dosage dependent manner. Adnexal structures such as hair follicles and sweat glands were only evident in FTSTC-treated wounds. Furthermore, whereas ungrafted wounds were marked by extensive infiltration of α-Smooth Muscle Actin+ (α-SMA+ ) myofibroblasts at POD 60, α-SMA expression was sparse and largely limited to perivascular cells in FTSTC-treated wounds. The number of Ki67+ cells was also greatly reduced in FTSTC-treated wounds. Transplantation of FTSTCs containing intact adnexa improved wound healing parameters in porcine full-thickness wounds and may have implications for the treatment of large, traumatic wounds.

Tissue engineering and surgery: from translational studies to human trials.

Tissue engineering was introduced as an innovative and promising field in the mid-1980s. The capacity of cells to migrate and proliferate in growth-inducing medium induced great expectancies on generating custom-shaped bioconstructs for tissue regeneration. Tissue engineering represents a unique multidisciplinary translational forum where the principles of biomaterial engineering, the molecular biology of cells and genes, and the clinical sciences of reconstruction would interact intensively through the combined efforts of scientists, engineers, and clinicians. The anticipated possibilities of cell engineering, matrix development, and growth factor therapies are extensive and would largely expand our clinical reconstructive armamentarium. Application of proangiogenic proteins may stimulate wound repair, restore avascular wound beds, or reverse hypoxia in flaps. Autologous cells procured from biopsies may generate an ‘autologous’ dermal and epidermal laminated cover on extensive burn wounds. Three-dimensional printing may generate ‘custom-made’ preshaped scaffolds – shaped as a nose, an ear, or a mandible – in which these cells can be seeded. The paucity of optimal donor tissues may be solved with off-the-shelf tissues using tissue engineering strategies. However, despite the expectations, the speed of translation of in vitro tissue engineering sciences into clinical reality is very slow due to the intrinsic complexity of human tissues. This review focuses on the transition from translational protocols towards current clinical applications of tissue engineering strategies in surgery.

The evolution of acute burn care - retiring the split skin graft.

The skin graft was born in 1869 and since then, surgeons have been using split skin grafts for wound repair. Nevertheless, this asset fails the big burn patient, who deserves an elastic, mobile and robust outcome but who receives the poorest possible outcome based on donor site paucity. Negating the need for the skin graft requires an autologous composite cultured skin and a material capable of temporising the burn wound for four weeks until the composite is produced. A novel, biodegradable polyurethane chemistry has been used to create two such products. This paper describes the design, production, optimisation and evaluation of several iterations of these products. The evaluation has occurred in a variety of models, both in vitro and in vivo, employing Hunterian scientific principles, and embracing Hunter's love and appreciation of comparative anatomy. The process has culminated in significant human experience in complex wounds and extensive burn injury. Used serially, the products offer robust and elastic healing in deep burns of any size within 6 weeks of injury.

Inhibition of TGF-β signaling promotes expansion of human epidermal keratinocytes in feeder cell co-culture.

Cultured epidermal autografts have been used worldwide since 1981 for patients with extensive third-degree burn wounds and limited skin donor sites. Despite significant progress in techniques toward improving clinical outcome of skin grafts, the long in vitro preparation time of cultured autografts has remained a major factor limiting its widespread use. Here, we show that pharmacological inhibition of TGF-β signaling promotes the expansion of human epidermal keratinocytes (HEKs) with high proliferative potential in co-cultures with both murine 3T3-J2 cells and human feeder cells, including dermal fibroblasts and preadipocytes. In contrast, TGF-β signaling inhibition does not enhance the growth of HEKs in a serum- and feeder-free condition, an alternative approach to propagate HEKs for subsequent autograft production. Our results have important implications for the use of TGF-β signaling inhibition as a viable therapeutic strategy for improving Green's methodology and for more efficient production of customized skin autografts with human feeder cells.

Cell-based skin substitutes accelerate regeneration of extensive burn wounds in rats

BackgroundThis study investigated the effects of amniotic membrane combined with adipose-derived stem cells or fetal fibroblasts on regenerating extensive burns in rats. MethodsThird degree burns of 1100–1800 mm2 were induced on 32 Sprague-Dawley rats. Burned sites were excised and randomly covered with Vaseline gauze (control), human amniotic membrane (HAM), human fetal fibroblasts seeded on HAM (HAM-FF), or human adipose-derived stem cells seeded on HAM (HAM-ASC), and followed by wound closure and histological assessments. ResultsWound closure rates of HAM-FF, HAM-ASC, HAM and control groups at seven and 14 days after the treatment were 42.2% and 81.9%, 41.9% and 81.7%, 33.5% and 74.2%, and 16.5% and 69.7%, respectively. Wounds of HAM-FF, HAM-ASC, HAM and control groups were closed on 40, 40, 50 and 60 days after the treatment, respectively (P < 0.05). Histological assessments revealed lower inflammatory cell infiltration in HAM-ASC and HAM-FF groups. ConclusionsCell-based engineered skin substitutes seem to accelerate wound regeneration, especially within the first 14 days.

To see the future development of burn medicine from the view of holistic integrative medicine

The therapeutic methods and effects have been improved greatly in the past few decades for burn care and management with several important advancements which have resulted in more effective patient stabilization and significantly decreased mortality in China. However, the challenges still exist, such as how to further improve the recovery of the patients' appearance and function, and how to advance the treatment of severe deep extensive burn injury, etc. The theory of holistic integrative medicine (HIM) provides a new opportunity for the development of clinical medicine. This article emphasizes the important roles of HIM in exploration of burn medicine, considering the advanced development of modern life sciences and relevant techniques.

To enhance study on translation and application of mesenchymal stem cells in wound repair

Wound repair is a complicated process of interactions among numerous types of cells, involving the activation of multiple cells and various cytokines. The extensive burn and chronic wound are already big challenges for clinic due to the limitations of existing treatment means. Stem cell technology, as a new therapy, may be the optimum choice for wound repair. Mesenchymal stem cells are multipotent cells with self-renewal and differentiation capacity and have a broad tissue distribution, which are promising in treating wound, and it is worthy to discuss and analyze their role, clinical translation and application in wound repair, the facing problems at present and solving strategies as well.

Examination of the Life Expectancy of Patients with Burns over 20% of Their Total Body Surface Area in Comparison to the Rest of the Population.

Patients with extensive burn injuries suffer from multisystem trauma, which affects their medical, psychological, and social well-being for many years. Monitoring those patients has revealed changes in the endocrine, cardiac, and respiratory systems years after the injury. Our study tries to examine whether changes manifest as a higher risk of death during their lifespan, compared with the general population. Data from the years 1998 to 2013 regarding two groups of patients was obtained from a national trauma registry: one group had suffered burns over 20% of their TBSA and survived the hospitalization period and the second group was a control group of patients admitted with minimal trauma (Injury Severity Score = 1-minor injury to a single body region). Mortality rates during the posthospitalization period were compared after adjusting for age and follow-up periods. The authors collected 1115 second- or third-degree burn victims with 20% TBSA and 81,688 trauma victims with an Injury Severity Score = 1. Follow-up periods ranged from 8 months to almost 17 years. When comparing the groups after correcting for age, sex, and follow-up period, no significant differences in mortality risk were found. Possible explanations for the lack of differences in mortality risk include the lack of an adequate follow-up period, a misguided research hypothesis (ie, despite existence of physiological changes in burn patients, these changes do not affect the lifespan), or a control group that does not optimally represent mortality in the general population.

Liver dysfunction in pathogenesis of burn disease and its correction with succinate-containing drugs

Current information on the effects of extensive and deep burns upon the liver functions as well as some novel methods of its correction with succinic acid derivates are reviewed. The liver is the main target organ for extensive burn injuries. Manifestations of cytolytic and cholestatic syndrome were observed already on the first days of the disease. To correct these conditions a comprehensive layout of the infusion of intensive therapy is needed. In burn disease it is impossible to restore the circulating blood volume only by infusion of plasma-substituting solutions. Thus, these cocktails must contain drugs, stabilizing metabolic disorders and reducing the concentration of proinflammatory cytokines. Complex intensive therapy in case of burns should also include correction of energy production within the cells without increasing oxygen transport. Substrate antihypoxic drugs are used in order to reduce the need of tissues for oxygen, stabilization of cell membranes and reduction of lipid peroxidation. Succinic acid is a substrate antihypoxic drug capable of detoxification, antihypoxic, antioxidant and hepatoprotective effects. Its derivates modify cellular respiration, compensate for metabolic acidosis, reducing lactate, pyruvate and citrate concentration, normalize histamine and serotonin concentration, improve microcirculation without affecting systemic hemodynamics. All of these effects are pathogenetically substantiated in the treatment of patients with burns. Data regarding the use of drugs on the basis of succinic acid in the treatment of patients with extensive deep burns, critical and supercritical burns during various periods of burn disease, their influence on the severity of multiple organ dysfunction in these patients, the presence of hepatoprotective effect are reported in a few of publications and their conclusions are so far ambiguous enough.

Changes in the Dermal Structure during Cultured Epidermal Autograft Engraftment Process.

Background:The use of cultured epithelial autografts for the treatment of extensive burn wounds has become popular in recent years. We examined extensive burn wounds in 14 patients by using a combination of autograft and cultured epithelial autografts developed in Japan (JACE).Methods:We undertook a skin biopsy at 2, 4, and 6 weeks after transplantation with JACE. By using electron microscopy we observed the engraftment process.Results:In transmission electron microscope findings, we recognized the engraftment process of JACE. Keratinocytes matured gradually. Collagen fibers formed thick bundles in the dermis layer. In scanning electron microscope findings, we observed papillary dermis development on the artificial dermis.Conclusions:After managing wound bed preparation by using artificial dermis, we were able to recognize the good result of grafting JACE on meshed 6:1 split thickness autografts. This is because the auto dermis from autograft extended under the JACE, binding between JACE, and the dermis became strong.

"Scarless world or scar-less world": expedition on new perspectives on management of post-burn hypertrophic scar.

Hypertrophic scar has always been the top priority of post-burn intervention. Specialists from multiple disciplines have dedicated enormous efforts expanding the knowledge in understanding the etiology of hypertrophic scar formation and establishing the scientific evidence of effective management of hypertrophic scar. The devotion and pursuit of these scientists and clinicians has been especially meaningful for the population in Asia since it has been well proven that hypertrophic scar was endemic to the Asian population comparing to the Caucasians. Besides early intervention, functional outcomes and long-term quality of life for people with extensive burn injuries have been investigated by different researchers and further substantiate the importance of long-term continuum of rehabilitation programs [1, 2].

Modified Meek Micrografting Technique for Wound Coverage in Extensive Burn Injuries.

The modified Meek micrografting technique constitutes a rapid and efficient surgical approach for the skin coverage of extensive full-thickness burn injuries. A total of 10 burn patients (mean 68 ± 9.2% TBSA) admitted to our burn unit required one or more Meek micrografting procedures (mean 2.2 ± 0.5) to cover in average 43.4 ± 11.6% TBSA (range between 10 and 75% TBSA). This goal was achieved using a donor site area ranging between 2.5 and 18% TBSA. All patients developed local infection to Pseudomona aeruginosa (75%), Stenotrophomona maltophilia (25%), methicillin-resistant Staphylococcus aureus (12.5%), and Acinetobacter baumannii (12.5%). Thus, the average of Meek regrafting after graft-take failure was 13.1 ± 6.4% TBSA (median: 9%; range from 0 to 36%). The period to obtain stable definitive wound closure was in average of 67.2 ± 21 days post injury. The modified Meek micrografting provides a reliable and versatile method for the coverage of large burn wounds with limited autograft donor sites and is now routinely used in our institution. Its systematic use improves operating times and overall outcomes reducing the number of surgeries, increasing the percentage of graft take, and decreasing the length of stay.

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

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. 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. 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. 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). 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.