Skin Bank Research Articles

From Bank Preparation to Clinical Use of Homologous Skin Allografts in Wound Healing: A Sustainable Approach.

Given progressive population ageing and the increase in the number of patients with comorbidities, the management of chronic and/or hard-to-heal wounds (HHWs) nowadays represents a common problem in many clinical settings. In these cases, standard strategies may not be sufficient. Autologous grafting represent the gold standard for permanent wound closure, but is almost never realized when the skin loss is extensive/the patient is young. The grafting of homologous skin/dermal tissue procured from cadaver donors (i.e., allografting) represents the best alternative, especially when the dermal component is lost. This request supports the activities of skin bank establishments (including donor screening, skin procurement, processing, storage, and distribution) that are regulated by specific guidelines and need to continuously meet quality standard requirements. The aim of this work is to both give specific insights of all the procedures implied in allograft preparation as well as an overview of their practical application in the treatment of different HHWs. The particular characteristics of each skin/dermal allograft released by Siena Skin Bank (cryopreserved/glycerol-preserved skin/de-epidermized dermis, acellular lyophilized de-epidermized dermis/reticular dermis) are also discussed. The exemplificative series of HHWs managed in the Dermatology Department of Siena were classified according their etiology into post-traumatic, vascular (arterial/venous/mixed/lymphatic), inflammatory, surgical, and heat/chemical burns. Globally, the clinical advantages obtained include: acceleration of healing process, pain sparing, resistance to bacterial contamination, dermal regeneration (instead of scarring), and better aesthetic-functional outcome.

A Study of Cadaveric Skin Graft Harvest and Usage: An Observational Prospective Pilot Study.

Background Burn injuries pose a significant global public health challenge, causing substantial morbidity and mortality, particularly in low- and middle-income countries. Timely and effective wound coverage is critical in treating severe burns to prevent infection, reduce pain, and promote healing. Cadaveric skin grafts (allografts) have become essential in treating extensive burn wounds, serving as temporary biological dressings to prepare the wound bed for autografting. This study aims to comprehensively analyze the process of cadaveric skin graft harvest and usage in a tertiary care setting. It seeks to evaluate the procedures, challenges, and outcomes associated with cadaveric skin grafts, contributing to optimizing burn care practices and improving patient outcomes. Methods This observational study was conducted at a tertiary care hospital and burns center with a skin bank, involving 44 cadaveric skin graft harvests and 27 applications between July 1, 2011, and June 30, 2013. The study focused on prospective donors and recipients needing cadaveric skin grafts. Inclusion criteria for donors included consent from the next of kin and the absence of infections or septicemia, while exclusion criteria included prolonged post-mortem intervals and medico-legal cases. The procedures adhered to the Euro Skin Bank protocols, encompassing retrieval, processing, storage, and usage. Data were analyzed using Epi-Info version 7.2.1 software, employing descriptive statistics for categorical variables. Ethical clearance was obtained from the university ethical committee, with mandatory written informed consent for skin donation. Results Out of 519 deaths in the tertiary care hospital, significant barriers to skin donation included septicemia, skin changes, late reporting, young age, medico-legal issues, and positive viral markers. Notably, 114 (21.97%) of next of kin refused consent. Cadaveric skin was harvested in five (11.36%) cases, with potential donors identified in 78 (15.02%) of deaths. Donors were predominantly older males, with efficient procurement processes ensuring timely harvests. The tertiary burns center facilitated 39 (88.63%) cases of cadaveric skin harvests with a skin bank, either at the donor's home or other hospitals notified to the burns center. Cadaveric skin grafts were applied in 27 cases, primarily for burns, with high graft uptake observed over 10 days. Non-healing ulcers showed 100% graft uptake. The survival rate among burn patients was 20 (74%), with deaths mainly due to sepsis and multi-organ failure. Significant barriers to obtaining consent included a lack of awareness, superstitions, social stigmas, and religious objections. Conclusion The study highlights the critical role of cadaveric skin in managing extensive wounds, particularly burns. Despite challenges in obtaining consent and limited donor availability, cadaveric skin grafts effectively prepared wound beds for autografting, contributing to improved patient outcomes. Increasing community awareness and addressing superstitions and social stigmas are essential for improving donation rates.

Knowledge, attitude and practice survey of bacterial contamination of blood for transfusion in the Democratic Republic of the Congo.

We assessed healthcare worker's knowledge-attitude-practice regarding bacterial contamination of blood products in the Democratic Republic of the Congo. In three hospitals and the National Blood Transfusion Center (NBTC), two multiple-choice surveys were completed on a tablet computer: one each, for blood bank (31 questions) and for clinical ward staff (20 questions). A score was calculated for 11 overlapping knowledge questions. Among 247 participants (blood bank No.=62, ward No.=185), median (range) knowledge score was 10 (2-19) on a maximum of 20, with blood bank staff (12/20) scoring higher than clinical ward staff (9/20) (p<0.0001). Half (50.2%) of 247 participants recalled previous training in transfusion medicine. Participants had limited understanding of and compliance with NBTC-recommended preventive measures: incorrect assumption that wearing gloves prevents bacterial contamination (83.8%) and that blood banks test donor blood for bacteria (59.9%). Half (50.0%) of blood bank staff did not acknowledge the NBTC-recommended antisepsis procedure, 62.1% did not apply the appropriate number of antisepsis steps, and 32.3% saw no harm in touching the venipuncture site after antisepsis. Presence of bacteria on healthy skin (62.3%) and blood bank fomites (examination gloves: 30.8%, soap: 62.8%) was underestimated. Although 92.4% of clinical ward staff said to easily recognize transfusion reactions, only 15.7% recognized septic reactions and post-transfusion antibiotic treatment practices were not consistent. Challenges reported by blood bank staff and particular for low-resource settings were: frequent power cuts (98.4%), transport of blood products by patient attendants (41.1%), without cooling elements (64.4%), and reuse of finished antiseptic/disinfectant containers (75.4%). The present study points to gaps in knowledge, attitudes, practices along sampling, cold chain and transfusion which can feed customized training and monitoring.

Improving Long-Term Projection in Nipple Reconstruction Using a New Human-Derived Acellular Dermal Matrix

Background: Loss of projection is a very common complaint after nipple reconstruction. In this paper, we present our experience with the use of a novel human cadaver-donor-derived acellular dermal matrix, named MODA (Matrice Omologa Dermica Acellulata) from the Regional Skin Bank to improve and stabilize nipple projection after oncoplastic breast surgery. Methods: We did a retrospective analysis of patients undergoing nipple reconstruction with local flap and MODA graft after breast reconstruction between February 2019 and May 2021. The analysis was done following the Declaration of Helsinki and was approved by the ethics committee; written consent was sought from all the participants. The main evaluation criterion was nipple projection measurement, performed immediately after surgery, 6 and 12 months postoperatively. The secondary endpoints were complications and patients’ satisfaction. Results: In this study, 50 patients underwent nipple reconstruction, with 57 reconstructed nipples. All cases except six followed delayed breast reconstruction. The patients were divided into 3 groups, according to the breast reconstructive technique. There were three cases of delayed wound healing and two cases of partial necrosis, but all of the cases healed by secondary intention. Five percent of the patients (3/57 reconstructions) presented more than 60% of nipple projection loss and required another procedure. The other reconstructed nipples maintained an average of over 60% projection after 12 months. Conclusion: The described technique presents a high success rate associated with low complications. Indeed, it provides the advantages of nipple reconstruction with ADM with low costs, appears safe after radiotherapy, and has similar results when used after different reconstructive techniques.

Organization of Hannover Skin Bank: Sterile culture and procurement protocols for viable cryopreserved allogeneic skin grafts of living donors.

Preserved allogeneic donor skin still represents one of the gold standard therapies in temporary wound coverage in severely burned patients or chronic wounds. Allogeneic skin grafts are currently commercially available as cryo- or glycerol-preserved allografts through skin tissue banks all over the world. Most of the skin tissue banks rely on human cadaveric skin donations. Due to the chronic shortage of human allogeneic transplants, such as skin, and increasing costs in the procurement of allografts from other skin tissue banks, Hannover Medical School has been building up its own skin tissue bank based on allogeneic skin grafts from living donors who underwent surgical treatment (i.e., body-contouring procedures, such as abdominioplasties). This article presents procedures and protocols for the procurement and processing of allogeneic skin grafts according to national legislation and European regulations and guidelines. Beside protocols, initial microbiological data regarding the sterility of the harvested grafts are presented. The results currently form the basis for further investigations as well as clinical applications. In summary, a microbiological testing and acceptance procedure is presented that ensures adequate patient safety and skin viability.

Skin Bank Establishment in Treatment of Severe Burn Injuries: Overview and Experience with Skin Allografts at the Vienna Burn Center.

Depending on their extent, burn injuries require different treatment strategies. In cases of severe large-area trauma, the availability of vital skin for autografting is limited. Donor skin allografts are a well-established but rarely standardized option for temporary wound coverage. Ten patients were eligible for inclusion in this retrospective study. Overall, 202 donor skin grafts obtained from the in-house skin bank were applied in the Department of Plastic and Reconstructive and Aesthetic Surgery, Medical University of Vienna. Between 2017 and 2022, we analysed the results in patient treatment, the selection of skin donors, tissue procurement, tissue processing and storage of allografts, as well as the condition and morphology of the allografts before application. The average Abbreviated Burn Severity Index (ABSI) was 8.5 (range, 5-12), and the mean affected total body surface area (TBSA) was 46.1% (range, 20-80%). In total, allograft application was performed 14 times. In two cases, a total of eight allografts were removed due to local infection, accounting for 3.96% of skin grafts. Six patients survived the acute phase of treatment. Scanning electron microscope images and histology showed no signs of scaffold decomposition and intact tissue layers of the allografts. The skin banking program and the application of skin allografts at the Vienna Burn Center can be considered successful. In severe burn injuries, skin allografts provide time by serving as sufficient wound coverage after early necrosectomy. Having an in-house skin banking program at a dedicated burn centre is particularly advantageous since issues of availability and distribution can be minimized. Skin allografts provide a reliable treatment option in patients with extensive burn injuries.

Mitigating the impact of skin necrosis in reconstruction after nipple-sparing mastectomy

Skin flap necrosis is a common postoperative complication after breast reconstruction, with an incidence of up to 43.4% among patients undergoing nipple-sparing mastectomy. Necrosis can adversely impact aesthetics due to the need to excise nonviable tissue, and increase the risks of infection, implant loss, nipple-areola complex sacrifice and malposition. Patient-specific factors including age, body mass index, and breast size may affect the risk of necrosis. Mastectomy and reconstruction techniques (i.e., choosing between skin- and nipple-sparing mastectomy, and between autologous and alloplastic reconstruction) may also influence necrosis rates. Intraoperative measures such as indocyanine green angiography and autologous skin banking, and the postoperative use of nitroglycerin paste for high-risk patients and warming blankets for autologous reconstruction are methods to help prevent and minimize the morbidity of skin necrosis. Herein, we share our institution’s approaches to predicting and mitigating skin necrosis, and methods of optimizing outcomes for breast reconstruction patients.

Live Skin Allograft for Coverage of Deep and Extensive Burns: First Experience in Morocco

The gold standard for closure of excised full-thickness burns is split-thickness skin autograft. Patients with very large burns have limited donor sites for harvesting of autograft and may benefit from the use of skin Allografts. Taken from cadaveric or human skin as part of tissue donation. Allograft skin has been widely used for wound management in burn centers. Functional as biologic dressing, it can not only provide ideal temporary wound coverage in extensive burns when autograft is not immediately available but also prepare the wound bed for definitive autografting. In this study, we present the results of the use of allograft from living donors in three children, the use of this live skin allograft has permitted to keep the children’s alive in a balanced physiologic state until autologous skin graft or spontaneous healing closed all wounds. The procedure of live skin allograft is simple and replicable, and can be applied in settings where no skin bank is available in the management of deep burns.

The Establishment of a High Standard Skin Bank in Taiwan as a Burn Care Pioneer

Introduction: The establishment of skin banks is especially important in providing crucial cadaveric skin for burn treatments. Although the 2015 Formosa Fun Coast Explosion Disaster resulted in tragic casualties, it raised public awareness of the importance of having a well-functioning skin bank and led to the initiation of a skin bank development project, as well as the establishment of the first high standard skin bank in Taiwan. Methods: We standardized the size of our procured skin to avoid broken or disrupted skin graft, fit properly on a Zimmer Dermacarrier® for mesh expansion, and to be convenient for storage. We also integrated gamma radiation with the glycerol stored skin method for our skin preservation which effectively eradicates all contamination. Results: From 2016 to 2020, 453,100 cm2 of skin were procured from 62 donors and stored in the NTUH skin bank; 254,000 cm2 of which were utilized in the treatment of 75 patients. Between 2016 and 2017, 141 microbiological examinations were administered with six were positive. Since the introduction of gamma radiation, no contamination has been observed hereafter in our examinations. Conclusions: We report the success of establishing a high standard and well-functioning skin bank at NTUH that supply sufficient skin allografts in Taiwan. It is the first interhospital supply of charitable skin allografts across Taiwan. Being humanitarian, our skin bank is passing great love forward.

Acid Attacks: The Gnawing Problem of Gender-Based Violence

Violence against women is rooted in unequal power relations between men and women. An acid attack (Vitriolage) is a gender based crime against women and is one of the most brutal forms of violence, in which acid is thrown onto the face and body of women with the intention of disfiguring her. This paper is an attempt to reflect the most gnawing issue of chemical assault with acid prevailing in India. It is much more intentional act and graver than even rape and murder. This gruesome crime footprints the victim miserable living condition or even it results in death. Acid is perhaps the most easily available lethal weapon, capable of causing death or at least permanent disfigurement and in some cases, blinding, quite instantly. Although acid attack can be resorted to against anybody, in India and other south-Asian countries, it has mostly been gender specific. This extreme form of violence has been used against women for taking revenge in cases of rejection of marriage proposals, sexual advances and as a means of domestic violence. As per the reports of the National Crime Records Bureau, there have been 1402 (source: Crime Statistics reports of NCRB2014 to 2018, released in January 2020) reported cases of acid attacks and attempts there to in these five years. The number of victims in these attacks as stated to be 1483. In such situations, it is very pertinent to discuss the present laws that governing this crime and the horrendous effects that acid attacks have on the victims-physically, psychologically, socially and economically. Additionally this paper, aims to bring acid attacks and the concept of skin banking in our mainstream conversations so that more and more people are aware of them. Donation of eyes has become a widespread practice, but people are still not aware of skin donation. Highlighting and talking about such causes openly and even on public platforms will help spread the word.

Biofilm formation and antibiotic susceptibility of Staphylococcus and Bacillus species isolated from human allogeneic skin.

Human skin banks around the world face a serious problem with the high number of allogeneic skins that are discarded and cannot be used for grafting due to persistent bacterial contamination even after antibiotic treatment. The biofilm formation capacity of these microorganisms may contribute to the antibiotic tolerance; however, this is not yet widely discussed in the literature. Thisstudy analyzed bacterial strains isolated from allogeneic human skin samples,which were obtained from a hospital skin bank that had already been discardeddue to microbial contamination. Biofilm formation and susceptibility topenicillin, tetracycline, and gentamicin were evaluated by crystal violetbiomass quantification and determination of the minimum inhibitoryconcentration (MIC), minimum biofilm inhibitory concentration (MBIC), andminimum biofilm eradication concentration (MBEC) by the broth microdilutionmethod with resazurin dye. A total of 216 bacterial strains were evaluated, and204 (94.45%) of them were classified as biofilm formers with varying degrees ofadhesion. MBICs were at least 512 times higher than MICs, and MBECs were atleast 512 times higher than MBICs. Thus, the presence of biofilm in allogeneicskin likely contributes to the inefficiency of the applied treatments as antibiotictolerance is known to be much higher when bacteria are in the biofilmconformation. Thus, antibiotic treatment protocols in skin banks shouldconsider biofilm formation and should include compounds with antibiofilmaction.

The Global Macroeconomic Burden of Burn Injuries

PURPOSE: The objective of this study was to quantify the global macroeconomic burden of injuries inflicted by fire, heat, and hot substances. BACKGROUND: Over nine million people suffer from thermal injuries annually across the world. Among those injured, 90% of mortality occurs in low- and middle-income countries (LMICs). The economic impact of the morbidity and mortality incurred as a result of such injuries remains unclear. Quantifying the financial impact of these injuries can educate government and non-governmental organization funding initiatives designed to increase access to care. METHODS: Data on incidence, mortality, and disability adjusted life years (DALYs) from injuries caused by fire, heat, and hot substances were collected from the Global Burden of Disease Study 2019. The global macroeconomic burden of burns in the form of welfare lost was calculated by multiplying GDP per capita and DALYs for 190 individual countries. Gross domestic product (GDP) per capita adjusted for purchasing power parity (PPP) data were collected from the World Development Indicator Database. Temporal trends from 2009 to 2019 were evaluated with a specific focus on sub-Saharan Africa and South Asia. RESULTS: In 2019, the incidence of burns was 1.2 million in South Asia and 1.3 million in sub-Saharan Africa compared with 0.5 million cases in the United States. Mortality rates were higher in both South Asia (2.6 per 100 patients) and sub-Saharan Africa (1.8 per 100 patients) than in the United States (0.7 per 100 patients). Between 2009 and 2019, the incidence of burns increased by 3.1% in sub-Saharan Africa and decreased by 4.0% in South Asia. Burn-related mortality decreased between 2009 and 2019 in both sub-Saharan Africa (20.0%) and South Asia (8.6%). Lifetime burden of disease due to burn injuries was 1,617,220 DALYs for sub-Saharan Africa and 1,876,506 DALYs for South Asia. In 2019, 11.7 billion USD in South Asia and 6.1 billion USD in sub-Saharan Africa were lost due to burns. This was equivalent to 0.10% and 0.15% of GDP, respectively. Welfare losses due to burns as a share of GDP within specific South Asian economies were 0.12% for India, 0.04% for Nepal, 0.09% for Pakistan, 0.07% for Bhutan, and 0.06% for Bangladesh. Welfare losses were highest in Papua New Guinea, equivalent to 0.63% of GDP. CONCLUSIONS: While mortality rates due to burns are decreasing over time, the impact on GDP remains significant; the impact on GDP exceeds that due to cervical cancer and HIV in South Asia and tuberculosis in sub-Saharan Africa. Temporal trends indicate that progress has been made in the treatment of burns in these regions. Additional resources, including intensive care units, skin banks, and hospital beds, may enhance care for patients with more severe burns and address the magnitude of injuries each year. In the setting of rising incidence, efforts designed to prevent burn injuries in the form of education are required. To convince governments to fund such initiatives in resource-limited environments, demonstrating the financial impact of burn injuries on a population level is one approach.

Glycerolised Skin Allografts for Extensive Burns in Low- and Middle-income Countries.

Introduction:There has been a significant improvement in the outcome of treatment of large surface area burns in developed countries. A major contributory factor is an early excision and skin grafting of burn wounds. The initial coverage of large surface area deep burn wounds requires the use of temporary skin substitutes such as allografts due to limited skin autografts. Cadaveric skin allografts are the commonest source of skin allografts in use; however, there may be religious, cultural, cost, or other factors mitigating its availability and routine use in low- and middle-income countries (LMICs). Human skin allografts may be used fresh or stored in tissue banks to ensure its ready availability. The purpose of this review is to promote glycerolised skin allografts as a means of skin preservation in low-resource countries above other modalities cryopreservation due to its cost advantages and relative ease of operation.Materials and Methods:A literature search for articles related to human skin allograft use in burn care, skin banks, and glycerolised skin allografts in LMICs was done using PubMed, EMBASE, and Web of Science databases. The key words used were ‘allograft’ and ‘burn’ with a filter in the search for human studies. The relevant references in the articles obtained were also searched for and included in the reviewResults:Sixty-three journal articles were reviewed for contents in line with the objectives of this study.Conclusion:Glycerolised skin graft is a viable option for coverage of extensive burns in LMICs.

Understanding and Perceptions of Skin Donation and Skin Banking among Health Care Professionals – Tertiary Care Centre in Eastern India

Introduction: The skin is our body’s most diverse organ. Other organs, such as the kidneys and liver, could be impaired and somehow still function, but the loss of 40percent of someone’s skin can be fatal. In developing countries, burns led to the deaths of the majority of people. The study aimed to establish the relationship between medical professionals’ awareness and attitudes regarding skin donation and skin banking. Methods: This cross-sectional survey was conducted at the All India Institute of Medical Sciences, Bhubaneswar, AIIMS, Odisha, between August 2020 to November 2020. A total of 124 health care practitioners from AIIMS, BBSR responded to the survey questions. It is divided into five sections: Social and economic data; Skin donation awareness survey, and skin bank attitude scale. Results: Less than half of health care professionals, 53.74 %, reported a lack of awareness of skin donation, and 56.16 per cent said lack of understanding of skin bank. The fair, positive relationship prevailed among skin donation awareness, and then either attitude (r=0.36, P=0.01), and a similar relationship existed between skin banking awareness and attitude (r=0.32, P=0.01). According to the report’s findings, having a clear understanding of skin donation and skin banking leads to positive behaviours. Conclusion: In this review, health care professionals’ awareness of skin donation and skin banking is average. Hospital and nursing administrators should be actively involved in education programmes to enhance nurses’ education and increase awareness about skin donation and skin banking.

The cost-effectiveness of maintaining an in-house glycerol-preserved skin bank

IntroductionGlycerol-preserved skin allograft (GPA) plays a vital role, especially in the management of burns injury. Where it is utilized as temporary wound closure, the considerably cost-effective, simpler handling and storage of GPA makes it preferable in almost all clinical indications. The GPA was first introduced to the Hospital Universiti Sains Malaysia in 2001. The supply was imported from Euro Skin Bank, Beverwijk, The Netherlands. In the year 2013, our center had started maintaining an in-house glycerolized skin bank. MethodWe preserved donor skin grafts from patients who underwent plastic surgery-related procedures in 85% glycerol and stored them at +2 °C to +10 °C. Cost estimation of the GPA per cm2 was calculated to analyze the effectiveness of its preservation technique. ResultsThe cost of GPA from our skin bank is estimated to be almost 90% reduction in cost as compared to the supply from Euro Skin Bank. ConclusionThe selective and strategic use of the GPA in major burn patients assure effective advantages in the treatment of burns. The clinical significance of skin allograft usage is very high. The cost-effectiveness of maintaining an in-house skin bank made it possible for various centers for skin allograft usage.

Immediate Reconstruction of Large Ptotic Breasts following Vertical Reduction Pattern Nipple-Sparing Mastectomy.

PurposeWomen with large and/or ptotic breasts are generally not considered candidates for nipple-sparing mastectomy because of concerns regarding the high incidence of postoperative complications including ischemic complications. Therefore, we adopted a vertical skin resection technique for nipple-sparing mastectomy, and obtained satisfactory results following immediate autologous breast reconstruction. In this study, we aimed to describe our operative technique and review its outcomes.MethodsBetween January 2010 and March 2017, immediate autologous breast reconstructions were performed in 28 patients with moderate or large ptotic breasts after nipple-sparing mastectomy using the vertical reduction pattern. Grade II ptosis was observed in 12 patients, and 16 patients were classified as having grade III ptosis.ResultsOf the 28 patients, 21 received abdominal free flap reconstruction. In the remaining 7 patients, extended latissimus dorsi flaps were used in conjunction with anatomic implants. The mean weight of the excised breast tissue in the 2 groups was 575 g and 482 g, respectively. Satisfactory esthetic outcomes without major complications were achieved in all patients. Similar vertical reductions or mastopexies in the contralateral breast allowed better postoperative adjustment for symmetry. There was only 1 case of complete nipple necrosis; however, the problem was solved with “skin banking.” No local recurrences or distant metastases were detected at follow-up (mean 18 months, range 4 months to 6 years).ConclusionTo enhance cosmetic outcomes in patients with large and/or ptotic breasts, the vertical skin resection pattern for nipple-sparing mastectomy can be used to achieve better breast shape while preserving the nipple-areola complex. Moreover, it can improve the esthetic outcome without compromising oncologic safety.

Skin bank of Curitiba, Brazil: epidemiology of donors and recipients

Skin bank of Curitiba, Brazil: epidemiology of donors and recipients

Aloenxertia e xenoenxertia de tilápia no tratamento de queimaduras pediátricas de 2º grau

The aim of this study was to study the use of tilapia allograft and tilapia xenograft in pediatric second-degree burns in terms of therapeutics and clinical-surgical results. This is a narrative literature review carried out through a survey of articles in the MEDLINE databases via PubMed, Cochrane Library, VIA ELSEVIER, BVS, LILACS, Scopus. Allograft is indicated for covering full-thickness wounds, healing partial-thickness wounds, as well as preparing the bed for subsequent self-grafting. This option, however, becomes limited by the insufficient skin banks in Brazil. Xenograft can be considered a therapeutic and socioeconomic solution. The use of Nile tilapia skin has benefits in the treatment of burns, and, in Brazil, the large production of this fish allows access to its skin due to the disposal of this by-product. Its use represents the progress of clinical and surgical management by analyzing its benefits, possible complications, and socioeconomic impacts, in addition to the need to explore new therapeutic methods for the best treatment based on available resources.

Skin substitutes for extensive burn coverage in Togo: A retrospective study

Four children, from 5 to 10 years aged, presented to the Sylvanus Olympio Hospital (SOTH) of Lomé (Togo) with severe (second- and third-degree) burns of 25–78% of total body surface area (TBSA) due to flame in domestic accidents and were treated using skin substitutes.We conducted skin substitution by dermal templates (Integra®) for two children and by skin allografts for the other two. In the two cases of dermal templates, we performed a wound excision on day 30 in one case, and on day 28 in the other. In one case, we associated the coverage with the dermal template to a negative pressure wound therapy; we applied skin graft on day 18 and day 21. In the follow-up, we observed no complication in both cases.In one of the two cases of skin allograft, we performed an eschar excision on day 8 and a donor skin allograft. we conducted another excision on day 15 while some parts were covered with skin autograft. The child died ten hours after the last procedure. The second patient had sequential excisions and coerage of some parts with skin allograft, and some others with skin autograft on day 42 In the fourth month, the child was discharged with a wound coverage of 74%, which was completed by another skin graft in the sixth month.The availability of dermal templates compelled the choice between the two skin substitutes. The access to other grafting options, such as a deceased skin bank, could allow the SOTH surgical team to step forward to the burn care.

179 Poster - A human-derived acellular dermal matrix for breast reconstruction: The first European experience

Background: The growing diffusion of direct-to-implant breast reconstruction (DTI-BR) following mastectomy for breast cancer (BC) is largely related to the introduction and increasing use in clinical practice of acellular dermal matrices (ADMs). Human-derived ADMs (H-ADMs) showed optimal outcomes in breast reconstruction and a better integration in the host tissues when compared with animal-derived products; according to the European legislation, H-ADMs are considered “human products,” subjected to the European laws on transplantation, and not “medical devices.” The Skin Bank of the Bufalini Hospital (Cesena, Italy) in 2009 obtained from the Italian National Transplant Center and National Health Institute the approval for the production and distribution of a new human cadaver-donor-derived ADM (named with the Italian acronym, MODA – Matrice Omologa Dermica Acellulata – Homologous Decellularized Dermal Matrix); in 2015 we started to use MODA in breast reconstructions following mastectomies for BC. To our knowledge, this is the first European experience about the routine use of H-ADMs in breast reconstruction surgery reported.