Burns : journal of the International Society for Burn Injuries
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In an effort to improve the take of finely meshed autografts a modification of the sandwich technique, as first published by Alexander et al. (1981), was developed. In contrast to the techniques described by other authors, the wound bed is sealed with fibrin glue spray after excision of the burns. Widely meshed autografts are then covered with non-meshed (only scarcely sliced) glycerolized allograft sheets, being fixed with staples. ⋯ During the weeks after transplantation, a creeping substitution of the allodermis by autologous tissue takes place. This would suggest a co-existence between glycerol-preserved hypo-allergenic allografts and auto-epidermis. Research on the definitive fate of allodermis in cases of sandwich grafting is continuing.
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Comparative Study
Expansion techniques for skin grafts: comparison between mesh and Meek island (sandwich-) grafts.
In skin grafting operations for patients with extensive burn injuries, mesh techniques are often employed to enlarge the effective surface area covered by autografts. However, substantial strips of autograft are required and the distribution of autograft elements on the wound surface is relatively uneconomical. An alternative technique for expanding autografts, first described by Meek in 1958, makes use of a special dermatome and prefolded gauzes to obtain a regular expansion of autograft squares from small pieces of split skin grafts. ⋯ The maximum distance between the graft elements obtained with the Meek technique was 9 mm, compared to a maximal distance between the strands of the mesh graft of 12 mm. The Meek technique is a useful alternative to mesh grafts when donor sites are limited. Clinical experience suggests that Meek grafts are also particularly suitable for grafting on granulating wounds under poor conditions.
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A method was developed to inflict standardized scald burns in the New Yorkshire pig. The tissue damage was compared to a standardized contact burn model. On each flank, six localizations were marked in a symmetrical way. ⋯ The tissue damage in the scalds showed an intermingled pattern of intact and damaged collagen. The more severe scald burns showed a structurally intact superficial vascular plexus, in combination with destruction of the deep vascular plexus. Current and new methods of scald treatment can be classified in this standardized animal model.
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Autologous keratinocytes cultured in vitro from skin biopsies of patients with deep partial and full skin thickness burns were grafted onto nine necrectomized wound surfaces between 17 and 25 days after injury. The cells were applied as nonconfluent single cells suspended in fibrin glue. ⋯ Keratinocyte grafted areas without cadaver skin overgraft showed less mechanical stability than when the keratinocyte-fibrin glue suspension was combined with allogeneic STSG. There is clinical and histological evidence that the allodermis may be partially integrated into the new skin.
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Multiple efforts to achieve immediate and complete burn wound closure following early debridement have been attempted to prevent septic complications, and to decrease the morbidity and mortality associated with major burns. The BG University Hospital Bergmannsheil Bochum (BGUBB) Burn Centre admitted 157 patients with deep partial thickness and full thickness skin burns during 1991 and 1992. ⋯ A total of 57 allograft transplantations were performed on these 28 patients. Our indications for the use of glycerolized human allografts, as well as our results, are presented and discussed.