Clinical Experience Using Cadaveric Skin for Wound Closure in Taiwan
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Index: WOUNDS. 2012;24(10):293–298.
Abstract: Taiwan’s skin banking program was initially set up to provide a ready source of cadaveric skin for patients with severe burns. However, human cadaveric skin may offer a useful alternative to conventional dressings in other wounds as well. Methods. In this retrospective review, cadaveric skin transplantation was used as temporary coverage in 145 patients with chronic ulcers, diabetic foot ulcers (DFU), necrotizing fasciitis, and acute traumatic wounds. Sex, age, number of debridements, and number of cadaveric skin transplantations were analyzed using statistical methods. Results. After clinical determination of engraftment 1 week after cadaveric skin allograft, skin samples harvested for histology in 15 cases revealed migration of epithelia from patient’s skin to the surface of cadaver skin and the presence of granulation tissue in the base of the cadaver skin. All wounds exhibited good wound-bed preparation after cadaveric skin transplantation, and could eventually be resurfaced with a skin autograft. Conclusion. Human cadaveric skin, in addition to being the mainstay in burn therapy, is a good biological dressing for chronic ulcers, DFUs, necrotizing fasciitis, and acute traumatic wounds.
Skin banking in Taiwan started in 2006 with the primary purpose of providing a ready source of skin allografts for severely burned patients to enable expedient wound coverage after early excisions of burn wounds. Many major burn centers use cadaveric skin as temporary biological dressings in cases of massive thermal injury. The relatively low cost and availability permit early, complete excision of the burn wound, which reduces mortality, length of hospital stay, and even blood loss.1–5 In addition, cadaveric skin mitigates pain and aids wound-bed preparation before the placement of autografts.6 Research demonstrates that many other applications in wound healing support the use of cadaveric skin as a true biological dressing.6
From the establishment of the skin bank at the Tri-Service General Hospital, Taiwan, in 2006 until 2011, human cadaveric skin was used as temporary coverage to treat 145 patients with chronic ulcers, diabetic foot ulcers (DFU), necrotizing fasciitis, and acute traumatic wounds.
In this study, the authors describe their clinical experience using human cadaveric skin in the treatment of various wounds, and compare the number of debridements and cadaveric skin transplantations performed among them. The histological features of the interface between the patient’s skin and the cadaveric skin were also analyzed.
One hundred forty-five patients with chronic ulcers, DFU, necrotizing fasciitis, and acute traumatic wounds treated at the Tri-Service General Hospital between 2006 and 2011 were included in this study. Wounds with exposure of bone were excluded.
All wounds underwent a series of debridements until no necrotic tissue or pus was found (Figure 1A-1B). Human cadaveric skin was obtained to cover the wounds. All cadaveric skin was harvested, processed, and frozen at the Tri-Service General Hospital skin bank in accordance with the guidelines of the American Association of Tissue Banks. All potential donors were screened for positive serology to hepatitis B surface antigen, hepatitis C, HIV, HTLV-1, and VDRL.