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LETTER TO EDITOR
Year : 2021  |  Volume : 29  |  Issue : 1  |  Page : 102-103

Resurfacing autograft-harvested donor sites with cadaver allograft in surgical management of extensive deep burns – A genesis of idea and its possible applications


Department of Plastic Surgery and Burns, St John's Medical College, Bengaluru, Karnataka, India

Date of Submission09-Jul-2021
Date of Acceptance09-Oct-2021
Date of Web Publication08-Jun-2022

Correspondence Address:
Dr. Narendra S Mashalkar
Department of Plastic Surgery and Burns, St John's Medical College, Bengaluru - 560 034, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijb.ijb_17_21

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How to cite this article:
Mashalkar NS. Resurfacing autograft-harvested donor sites with cadaver allograft in surgical management of extensive deep burns – A genesis of idea and its possible applications. Indian J Burns 2021;29:102-3

How to cite this URL:
Mashalkar NS. Resurfacing autograft-harvested donor sites with cadaver allograft in surgical management of extensive deep burns – A genesis of idea and its possible applications. Indian J Burns [serial online] 2021 [cited 2022 Nov 28];29:102-3. Available from: https://www.ijburns.com/text.asp?2021/29/1/102/346903



Sir,

Resurfacing of extensive deep burns wounds with autografts remains a challenge as there is a severe paucity of native unburnt skin. The third-degree burn wound requires excision and resurfacing with autograft as it would otherwise lead to infection and leads to sepsis with mortality as the end result. Surgical management is a double-edged sword wherein excision will create raw areas, and a temporary cover with allograft of these excised wounds is life-saving and is practiced widely.[1]

Allograft has many advantages when placed on the wound in controlling infection, pain, and protein loss with many other uses.[2],[3] Permanent cover with patient's own skin is ultimately necessary and mandatory. Harvesting autografts in such extensive burns will add insult to injury by increasing the raw areas in a patient with extensive burn wounds, but resurfacing with autograft is the only option left to salvage and give a permanent cover.

Every effort has to be done to the best and maximum possible to bring down the areas of wounds in a timely manner, by combined allografting and autografting.[4] We need to remember that while harvesting autografts, we create partial-thickness wounds, which will add to the morbidity; this matters a lot in extensive burn wound patients; hence, resurfacing even those wounds that we create also should be considered for resurfacing with allograft.

As we embarked upon resurfacing in such situations, we have come up with multiple permutation and combination of using both allografting and autografting and thus covering the wounds as much as possible. So much so that we started laying allograft on the donor sites after harvesting auto skin grafts hoping that the allograft would give the same advantages as it would provide when laid on the excised wounds. Upon resurfacing with allograft on the autografted-harvested donor sites, the pain and soakage component have been decreased considerably, and the patient is more comfortable with increased compliance in high protein intake.

To conclude, the lesson we have learned is that wounds when large have to be resurfaced quickly, and a combination of allografting and autografting has to be seriously considered; further, creation of new wounds by harvesting autografts in an already exhausted patient will lead to increasing morbidity and mortality. These new wounds created may be effectively covered with a layer of allograft in an effort to bring down the protein loss. Every act in reducing the raw area is significant and makes a difference in salvaging a burn patient with extensive deep burn wounds.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Brown JB, McDowell F. Massive repairs of burns with thick split-skin grafts: emergency “dressings” with homografts. Ann Surg 1942;115:658-74.  Back to cited text no. 1
    
2.
Kagan RJ, Robb EC, Plessinger RT. Human skin banking. Clin Lab Med 2005;25:587-605.  Back to cited text no. 2
    
3.
Wang C, Zhang F, Lineaweaver WC. Clinical applications of allograft skin in burn care. Ann Plast Surg 2020;84:S158-60.  Back to cited text no. 3
    
4.
Alexander JW, MacMillan BG, Law E, Kittur DS. Treatment of severe burns with widely meshed skin autograft and meshed skin allograft overlay. J Trauma 1981;21:433-8.  Back to cited text no. 4
    




 

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