Use of Fresh Scalp Allografts From Living Relatives for Extensive Deep Burns in Children: A Clinical Study Over 7 Years

Availability, effectiveness and safety of cadaveric and fresh allogeneic skin grafts in pediatric burn care-a review

Burn injuries in children are a critical public health issue with significant mortality and morbidity. Allogeneic skin grafts, both cadaveric and freshly donated, have been utilized in pediatric burn care since many years, yet their efficacy and safety remain to be systematically assessed. This systematic review (PROSPERO number: CRD42024560654) analyzed studies from 01/2000 to 07/2024 sourced from PubMed. Inclusion criteria targeted RCTs and retrospective studies focused on the use of allogeneic skin grafts in pediatric burn patients. Extracted data were presented in a narrative synthesis and a comprehensive table. Established tools were used for risk of bias assessment. 13 studies were deemed suitable for analysis, with only two qualifying as RCTs. Allogeneic skin grafts have shown promise in managing pediatric burns, especially in resource-limited settings where autografts or skin substitutes are not available. Studies varied in their treatment approaches, with allogeneic grafts often used for more severe burns, suggesting that observed adverse effects may be due to injury severity rather than treatment type. The retrospective nature of the majority suggests a limited level of evidence. Moreover, the heterogeneity among study designs and patient populations makes it difficult to draw definitive conclusions. Allogeneic skin grafts represent a valuable treatment option in pediatric burn care. However, further well-designed RCTs are essential to establish a stronger evidence base for their use and to guide clinical decision-making. The current literature underscores the potential of allogeneic grafts but also the necessity for more nuanced research tailored to pediatric needs.

Multimodal Optical Monitoring of Auto- and Allografts of Skin on a Burn Wound

The aim of the study was to investigate the dynamics of the state of allo- and autografts of skin on a wound using optical modalities: diffuse reflectance spectroscopy (DRS), optical coherence tomography (OCT), and laser Doppler flowmetry (LDF). A deep thermal burn was simulated in 24 rats covering 20% of the body surface. On day 3 after the injury, a fascial necrectomy of two 500 mm² areas on the left and right sides of the midline of the animal body were excised. Allografts and autografts were placed in the centers of these areas. Optical measurements of grafts were performed on the 0, 3rd, 6th, 10th, and 13th days after transplantation. The allografts demonstrated a pronounced decrease in oxygenation, blood content, and perfusion compared to autografts on the 6th day; in the following days of observation, these values returned to the average values of autografts. Water content gradually decreased from the beginning to the end of observation. In conclusion, optical diagnostics revealed changes in the morphological microstructure, the rate of restoration of blood circulation, and oxygen exchange in the early stages, specific for the allo- and autograft.

Glycerolised skin allografts for extensive burns in low- and middle-income countries

Introduction:

There has been a significant improvement in the outcome of treatment of large surface area burns in developed countries. A major contributory factor is an early excision and skin grafting of burn wounds. The initial coverage of large surface area deep burn wounds requires the use of temporary skin substitutes such as allografts due to limited skin autografts. Cadaveric skin allografts are the commonest source of skin allografts in use; however, there may be religious, cultural, cost, or other factors mitigating its availability and routine use in low- and middle-income countries (LMICs). Human skin allografts may be used fresh or stored in tissue banks to ensure its ready availability. The purpose of this review is to promote glycerolised skin allografts as a means of skin preservation in low-resource countries above other modalities cryopreservation due to its cost advantages and relative ease of operation.

Materials and Methods:

A literature search for articles related to human skin allograft use in burn care, skin banks, and glycerolised skin allografts in LMICs was done using PubMed, EMBASE, and Web of Science databases. The key words used were ‘allograft’ and ‘burn’ with a filter in the search for human studies. The relevant references in the articles obtained were also searched for and included in the review

Results:

Sixty-three journal articles were reviewed for contents in line with the objectives of this study.

Conclusion:

Glycerolised skin graft is a viable option for coverage of extensive burns in LMICs.