Glycerol-preserved Allograft Research Articles

Antimicrobial Effect of Skin for Allograft and Management in Burn Wound

One of the most important functions of skins is to protect our bodies from microbes or pollutant sources. Skins containing physical substances serve as a physical barrier which protects our bodies from pathogens. A healthy skin contains a variety of antibacterial substances such as defensin, cathelicidin and psoriasin. However deep and wide burns cause the skin to lose its original functions, so our skins are exposed to various danger factors. For the burn patients, human alloskin graft serves as a very important temporary biological wound dressing. It protects the wound before autograft procedure, forms revascularization and granulation tissues and protects the wound from an invasion of microbes. This study was conducted with the aim to analyze the antimicrobial effect of cryopreserved allograft (CPA) and glycerol-preserved allograft (GPA) which was a type of allograft widely used for burn patients, and measure the difference in comparison with the fresh skin before processing it. The most common contaminants found in burn patients such as S. aureus, P. aeruginosa, C. albicans and E. coli, were used for experiment. The antimicrobial effect against S. aureus and E. coli was observed in fresh skin and some CPA. In some clinical cases, infection is frequently observed in the wounds treated with allograft, indicating the allograft completely block every kind of microbes. To prevent the infection, it is required to use antibiotics and manage wounds thoroughly.

Treatment of necrotising fasciitis using glycerol-preserved skin allografts for temporary wound coverage

Allografts of human skin have been used for both temporary and permanent wound coverage. They are useful as temporary bridges for the critically ill patient who is not allowed to receive definite wound coverage, or for wound bed preparation before permanent grafting. Glycerol-preserved skin allografts have several benefits including good adherence to the wound bed, water vapour transport, antimicrobial characteristics, low toxicity and antigenicity, ease of application and removal, a long shelf-life, and minimal storage requirements. We achieved lower limb salvage using a glycerol-preserved skin allograft for temporary wound coverage in the treatment of necrotising fasciitis.

The Use of Glycerol-Preserved Skin Allograft in Conjunction with Reconstructive and Flap Surgery: Seven Years of Experience

Major reconstructive surgery may be extensive and prolonged, and it may cause edema and compromise the flap pedicle if closed under tension. Glycerol-preserved skin allograft (GPA) can provide a means for tension-free closure and temporary cover of the wound. Seven years of analysis on GPA used in conjunction with major reconstruction was undertaken to highlight its indications, results, and outcomes. Forty-seven patients were included, aged between 9 and 73 years. Majority of patients had reconstruction following tumor resection and trauma. The main indication for use of GPA was temporary, loose cover of the wound in 44% of cases; flap pedicle protection in 31% of cases; donor site wound cover in 10%; flap monitoring in one case; and management of flap-related complications in 6% of cases. Free flap reconstruction was performed in 72% of cases. In conclusion, GPA is a useful adjunct in reconstructive surgery. It can be used temporarily to allow tension-free wound closure, as well as to protect the flap pedicle until edema subsides and the pedicle becomes stable. This latter approach allows secondary wound closure and good esthetic outcome.

Evolving practice of the Helsinki Skin Bank

The purpose of this study is to review the management and running of the Helsinki Skin Bank between the years 2001 and 2008. Further aims were to assess the microbiological safety of the glycerol-preserved allograft skin and analyse its clinical use. The files of the Helsinki Skin Bank were reviewed for allograft skin harvested from organ donors between 2001 and 2008. Data on harvested skin area and microbiological culture results were collected. The patients receiving allograft were also identified and operation indications analysed. Allograft skin was collected from 115 donors, with a mean of 44,335 cm(2) per year. No skin batches were discarded. Microbiological cultures of the allograft skin batches were negative in 86 (75%) cases. Thirty-five donor skin batches were used in 69 operations. The most common indication was 'Biological dressing on partial-thickness burns', comprising 52% of cases. The cost per cm(2) was 0.81euro. The use of allograft skin in the Helsinki Skin Bank is microbiologically safe and continues to provide a versatile and useful treatment modality in many major burn cases with few observed complications. As compared with synthetically produced temporary dressings currently available, our allograft skin is also more economical.

Glycerol-preserved skin allograft (GPA) in the management of burn injuries and as an adjunct in free flap surgery: Seven years experience

Glycerol-preserved skin allograft (GPA) in the management of burn injuries and as an adjunct in free flap surgery: Seven years experience

The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction

ABSTRACTSkin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome.

The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction.

Skin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome.

A historical appraisal of the use of cryopreserved and glycerol-preserved allograft skin in the treatment of partial thickness burns

Two studies into the use of allograft skin in the treatment of partial thickness burn injuries in this burn centre have provided the opportunity to discuss changes and similarities over a 20 year period. The first study described results obtained with cryopreserved allografts in partial thickness burns in the period 1979–1981. The second study concerned patients with partial thickness injuries treated with glycerol-preserved allografts in the period 1998–2000. A reduction was noted concerning the need for secondary autografting in the group treated with glycerolized allografts. The probability that this difference has occurred by chance is small ( P=0.089). Various other factors that might account for the differences in outcome, include general improvements in health and social welfare, differences in treatment protocols, and differences in allograft properties. A prospective comparative trial is indicated to study direct differences between the two types of allograft.

The use of glycerol-preserved allografts in the Beverwijk Burn Centre: a retrospective study

This report describes 156 consecutive patients treated with glycerol-preserved allograft skin (GPA) in the Beverwijk Burn Centre between January 1996 and July 2001. Patients with burn and non-burn lesions are included. Age varied from 7 months to 90.7 years. Four different procedures have been identified: (1) sandwich grafting technique; (2) treatment of partial-thickness burns with GPA as a membranous dressing; (3) improvement of wound condition; (4) scar release: a temporary coverage of release incisions with allograft skin to improve the wound bed and to benefit further relaxation of the wound primary to autografting. The main points of interest in this inventory are the results of treatment, the aetiology and the extent of the wounds treated with GPA, the day post injury the GPA treatment was started, the duration of the treatment, the number of allograft applications, the occurrence of wound infection and wound treatment before GPA application. Concerning the scar release an inventory was made of the anatomic sites that were involved. Sandwich grafting, which is the treatment of choice at this centre for extensive, full-thickness injuries, was performed on 129 wounds. The average burn size in all 70 patients treated was 35.6% TBSA with 26.9% full thickness. In all cases meshed GPA was used. Partial or complete healing was achieved in 57.6% of wounds. In the treatment of partial-thickness burns, non-meshed GPA was used in all 57 cases. Complete healing without further treatment was achieved in 45.6% of the cases. Excision and autologous skin grafting was needed in 26.3% of the cases. Meshed GPA was used to improve the condition of 88 non-healing wounds. Spontaneous healing was promoted in 13.6% of the wounds, and the wound bed was successfully prepared for autografting in 39.8% of the cases. In all 52 scar releases a viable wound bed was obtained prior to autografting. Autologous graft take was 100% and no autologous re-grafting was necessary. Allografts in the popliteal space were changed most frequently.

The use of allografts in the management of exposed calvarial electrical burn wounds of the skull.

Deep burns of the scalp and skull are often caused by high voltage electrical injuries. In an early stage, protection and preservation of the skull is important. Covering the wound with a full-circulatory skin flap or a myocutaneous free flap is a reasonable selection, but is not our first choice. In our experience, preliminary use of glycerol-preserved allograft wound dressing significantly improved the development of granulation tissue to perform an autograft at a later stage. With these allografts, there is a significantly shortened healing time compared with the results found in the literature.

Use of glycerolized cadaver skin for the treatment of scalds in children

This report describes the personal experience of the authors with glycerol-preserved allograft applied to 84 young children with scalds.