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KMID : 1190620050010010072
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Journal of the Korean Wound Care Society
2005 Volume.1 No. 1 p.72 ~ p.77
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The Experience of the Fresh Allograft Skin in the Treatment of Massive Pediatric Burns-Using a Living Related Donor
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Chun Wook
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Abstract
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The procedure using the allograft skin from a cadaver has been the safest standard treatment for patients with extensive burns. Nevertheless, in reality, medical legal problems and the cultural influence of a Confucian tradition which prevents extracting organs from a cadaver, made it impossible to use the skin from a dead body in Korea. We were able to treat massive pediatric burns successfully using thin allograft skins obtained from the patients’ parents. 1. After collecting skin (a thickness of 7/1,000 inch) from the parent’s thighs, a 1：2 meshed fresh allograft skin was prepared. 2. The tangential excision was performed for burn areas. 3. For areas with a remaining dermis after performing the excision, only allograft skins were grafted. For cases with an exposure of the fat tissue layer, a sandwich method (1：6 meshed autograft with 1：2 meshed allograft) was used. An autograft was performed for areas with a formation of granulation after the allograft skin had come away. Nine pediatric subjects were included in this investigation. The mean age was 4.1 (1∼9) years old. The average burn area was 44.4 (25∼75)%TBSA. There were 6 cases with scalds and the other 3 cases were flame burns. The mean area of the allograft skin used was 37 (22∼65)%TBSA. A dimension of 3∼7%TBSA was used for performing the sandwich grafting method. Allograft skins adhered 100% and no wound infection developed in the grafting areas. Allograft skins began separating from about 10 to 12 days after grafting, and then came off within several days. Septicemia did not occur in any patient and we were able to heal an area of 0∼35%TBSA without an autograft. Until the blood supply to a fresh allograft stops (7 or 10 days after the graft), it is strong against any infection due to relatively quick vascular connections. Thus, even if some eschars remained after wound excision, the grafted area could be healed or tissue granulation may occur without infection. The majority of pediatric burns are scalds. Therefore, there are more second-degree burns in these patients than that of flame burn cases. Using fresh allograft as a temporary wound cover after a prompt tangential excision, many areas can heal by themselves. (J Korean Wound Care Soc 2005;1:72-77)
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KEYWORD
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Fresh allograft skin, Pediatric, Major burn
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