31/70. Use of cultured human epidermal keratinocytes for allografting burns and conditions for temporary banking of the cultured allografts.Five children who suffered burns clinically regarded as full skin thickness loss were grafted with cultured allogeneic skin from newborn prepuce. The wounds had remained open and infected without healing for about 20 days before the patients were received in the burn unit. To avoid losing surviving deep epidermal cells the wounds were debrided but not deeply excised and, a few days before allografting, they were washed with isodine solution and sterile water, and treated with silvadene cream application. All children received 76 cultured allografts of about 60 cm2 each. After allografting, the wounds were epithelized in 7-10 days and the allogeneic grafted skin began desquamation suggesting that the allograft did not 'take' permanently but was replaced by the newly formed skin. On the other hand, since allografting is an adequate therapy to provide early temporary coverage in extensively burned patients, we developed conditions for banking cultured skin to make it available for immediate use. The conditions described allow banking of the cultured grafts for 15-20 days with retention of clonal growth ability similar to that of unstored epithelia. The results show that cultured epidermal cells obtained from human newborn foreskin, when used as allografts for coverage of full skin or deep partial skin thickness burns, allow rapid epithelization of the burn wounds.- - - - - - - - - - ranking = 1keywords = allograft, allogeneic (Clic here for more details about this article) |
32/70. Successful homografting in an elderly patient with extensive burns using his identical twin brother as skin donor.A 60-year-old patient with 50 per cent body surface area (BSA) flame burns (of which 46 per cent were full skin thickness loss) was treated successfully with skin grafts taken from his identical twin brother to cover 20 per cent of the wounds. On theoretical grounds, it can be assumed that the period in hospital was reduced by 28 days. Blood for tissue and blood group typing should be taken at an early stage, before the patient is given a blood transfusion.- - - - - - - - - - ranking = 0.50795378508159keywords = homograft (Clic here for more details about this article) |
33/70. Use of cultured epidermal autografts and dermal allografts as skin replacement after burn injury.An adult with burns over 55% of body surface area (80% of which were third degree) was treated with cadaver skin allografts. The allografts were later abraded to remove allogeneic epidermis and resurfaced with autogenous keratinocyte cultures. Complete reconstitution of skin, consisting of epidermal autograft and dermal allograft, was achieved.- - - - - - - - - - ranking = 0.5keywords = allograft, allogeneic (Clic here for more details about this article) |
34/70. The fate of meshed allograft skin in burned patients using cyclosporin immunosuppression.Three patients with burns of 35%, 60% and 25% were treated with cyclosporin after the application of allograft skin. Biopsies of the allografts were taken at appropriate intervals. The drug was continued for 3 weeks, 3 months and 3 weeks respectively without ill-effects on the patients. The allografts survived during cyclosporin treatment but were rejected 12 days after cessation of treatment in Case 1 and 5-7 days in Case 2. In Case 3 where a meshed auto/allograft 'sandwich' technique was used, there was no visible evidence of rejection. It is likely that the allograft was replaced by a "creeping substitution" in the sandwich technique. The Langerhans cell is probably not solely responsible for allograft rejection.- - - - - - - - - - ranking = 0.69958836916015keywords = allograft (Clic here for more details about this article) |
35/70. Long-term skin allograft survival after short-term cyclosporin treatment in a patient with massive burns.In a child with extensive burns, cyclosporin was given to extend the survival of cadaveric skin allografts obtained from numerous unmatched donors. No evidence of graft rejection was seen, either during treatment or in the 2 years after cyclosporin was withdrawn.- - - - - - - - - - ranking = 0.34979418458007keywords = allograft (Clic here for more details about this article) |
36/70. Cross-linked silver-impregnated skin for burn wound management.Biological skin is effective in restoring the missing water vapor barrier and promoting healing in burn wounds. Its effectiveness in wound management has been limited, however, by its inherently limited antibacterial properties and the fact that it is sometimes rejected before healing is complete, even reversing previous beneficial effects. Limited availability and storage difficulties have posed further problems. Impregnation of biological skin with silver ions has been proven to provide a potent bactericidal effect directly at the wound surface. We hypothesized that aldehyde cross-linking of silver-impregnated skin would mask the histocompatibility sites from the recipient's immune system. This has been demonstrated previously with aldehyde cross-linking of allografts and xenografts, prolonging retention sufficiently to permit complete wound healing. Commercially available skin was treated with an aldehyde compound and impregnated with silver. Initial studies of this cross-linked skin for treatment of burn wounds showed average retention to be between 117 and 161 days, far exceeding that of any untreated skin. It was subsequently found that the aldehyde cross-linking permitted impregnation with higher concentrations of silver than had previously been possible--2,600 to 2,830 ppm as compared to an average of 1,020 to 1,350 ppm in previously available silver-impregnated skin. This results in a more potent, immediate antibacterial effect at the wound surface and an extended period of time-release antibacterial action before the silver is exhausted. The antibacterial properties of this aldehyde cross-linked silver-impregnated skin are effective in decontaminating even grossly infected wounds and in protecting against contamination of clean wounds from adjacent infected areas or external sources.(ABSTRACT TRUNCATED AT 250 WORDS)- - - - - - - - - - ranking = 0.069958836916015keywords = allograft (Clic here for more details about this article) |
37/70. Cultured epithelium as a skin substitute.Twenty-five burn patients with full or partial thickness skin loss received cultured epithelium (CE), allografts or autografts as part of their treatment. overall, a 30 per cent graft 'take' was achieved irrespective of whether the CE was autograft or allograft, fresh or frozen. In the case of deep dermal burns this figure improved to 50 per cent. The surviving grafts merged with split thickness skin grafts (SSG) and advancing wound edges. When full thickness skin loss was grafted, only a patchy take could be achieved and the surviving islands of CE tended not to spread across the wound. No rejection of CE allograft was recorded either clinically or histologically up to 6 months. The technical problems and clinical implications are discussed.- - - - - - - - - - ranking = 0.20987651074804keywords = allograft (Clic here for more details about this article) |
38/70. Composite autologous-allogeneic skin replacement: development and clinical application.A major unsolved problem in skin restoration in severe burns is replacement of lost dermis. We report the development and clinical application of a composite grafting technique in which allogeneic skin is the source of dermis, and cultured autologous keratinocytes generate epidermis. Excised burn wounds are resurfaced with unmatched allograft. immunosuppression from the burn and reduced immunoreactivity of the allograft permit successful allograft engraftment. Keratinocyte cultures are initiated from the patient. Allogeneic epidermis is removed, and the dermal bed is resurfaced with keratinocyte cultures. The allogeneic dermis promotes rapid (less than 7 days) stratification, maturation, and integration of the cultures and the synthesis of anchoring fibrils. One case followed 11 months has shown no evidence of rejection. We reason that removal of the epidermis from allograft eliminates the majority of cells constitutively expressing alloclass II antigens, leaving behind a viable allogeneic dermal bed that serves as an ideal substrate for engraftment and integration of keratinocyte cultures but does not initiate rejection.- - - - - - - - - - ranking = 0.35185233877934keywords = allograft, allogeneic (Clic here for more details about this article) |
39/70. Use of the Y-body for identification of skin source on a successfully grafted burn patient.The use of the interphase male Y-body (fluorescent y chromosome segment) technique with cryostat sections of both fresh and frozen-stored skin biopsies is described. A female burn patient appeared to retain her donor homografts, thereby negating the need for autografts. Since a retained homograft of this sort challenged our understanding of immunologic barriers, we applied the Y-body technique to cutaneous biopsies obtained from the patient's burn area that had been homografted with skin from a male donor, as well as control biopsies from the patient's unburned skin and normal control male and female skin. Based on clinical and cytogenetic observations, it was concluded that the most reasonable explanation for this case was that the regenerating tissue at the graft site was that of the recipient and not that of the originally grafted male skin.- - - - - - - - - - ranking = 0.38096533881119keywords = homograft (Clic here for more details about this article) |
40/70. Successful treatment of a severely burned elderly patient with homografts from her identical twin sister.A case is reported of the permanent survival of split skin homografts from the twin sister of a 65-year-old women with 50% burns. This is the first time this has been reported in the elderly. As the homo- and autografts demonstrated the same survival pattern, the conclusion was drawn that the patient and her sister were very probably monozygotic twins. This was confirmed later by the results of the tests for HLA-typing, mixed lymphocyte studies and red blood cell antigens.- - - - - - - - - - ranking = 0.63494223135198keywords = homograft (Clic here for more details about this article) |
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