Assessment of biological response of lyophilized cadaveric skin allograft in post burn raw area and nonhealing ulcers

Introduction: Extensive full-thickness burns and major injuries resulting in extensive damage to the skin make spontaneous regeneration difficult and compromise patient survival. When a donor area is available, it is always preferable to proceed with autograft, which is considered to be the best option. However, if the affected region is extensive, donor area is not enough, or when medical condition of the patient does not permit immediate grafting with autologous skin; in such conditions lyophilized skin allograft can be used for temporary coverage of the wounds. Materials and Methods: In this prospective study, evaluation of biological response of lyophilized cadaveric skin allografting was done in 100 cases of thermal burn and nohealing ulcers. Results: In this study, 19% cases lyophilized skin grafts got rejected in 3 weeks, 65% in 1 month, and in 16% patients graft got rejected at the end of 2 months. Rejection is defined as when skin graft becomes hard and starts separating from wound edges and is finally totally detached from the bed. Out of 100 patients, wounds healed completely in 81 patients, while 19 patients required autografting. On pus culture examination out of 100 patients, 26% patients showed the presence of infection. Histopathological study was done on the 21st postoperative day and all those who survived skin graft showed infiltration of mononuclear cells, fibroblasts, keratinization, uniformly arranged collagen bundles, and angiogenesis at the junction of graft and graft bed. All grafts that were rejected, showed acanthosis, spongiosis, and degenerative changes in vascular walls. Neovascularization was not observed in these grafts. Conclusion: Lyophilized cadaveric allograft acts as mechanical and physiological barrier and the process of lyophilization helps in minimizing the immunoreactivity of the graft, therefore, rejection is not rapid. Lyophilized cadaveric allografts can be lifesaving in cases of severe burn.

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