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Skin grafting has been an essential part of treating burns for over a century. The first published report, from London in 1871, involved an eight-year-old girl with severe leg burns who received transplants of her own skin and that of an unrelated adult male. Although the donated skin was rejected after two months, it was found to have stimulated wound healing. Developments in surgical techniques and implements followed rapidly, prompted especially by World War II-caused burn traumas. By the mid-1970s a dozen special burn-treatment centers had arisen around the U.S. Among them was The Burn Center at the New York Presbyterian Hospital, which is one of the leading such facilities in the world. Staffed with a multidisciplinary team of experts-attending burn surgeons, surgical assistants, and nurses; occupational, recreational, and physical therapists; social workers, a chaplain, and a nutritionist-it provides state-of-the-art treatment from initial intensive care through convalescence and rehabilitation. It also offers family accommodations during critical stages of treatment. In 1998 alone, 4,000 outpatients were treated and more than 1,000 patients-a third of them children-were admitted to The Burn Center. There are now dozens of burn-treatment centers across the country. For the location of one near you, contact the American Burn Association at 1-800-548-2876. How Donor Skin Helps Save Lives Ideally, the skin to be grafted for permanent wound coverage is harvested from the patient's own intact body areas (a process referred to as autografting). However, there are several situations where it is necessary-and even preferable-to use donated skin from a cadaver (which is called homografting): • Cadaver skin plays a critical role when more than 70 percent of a patient's body surface has been burned. Because the presence of dead tissue is a set-up for overwhelming sepsis, infection is one of the main causes of death in severe burn cases. Therefore the burned skin must be removed as soon as possible. If the patient suffers third degree burns (affecting the full thickness of the skin), those areas must be replaced with a "homograft," a thin shaving of skin from a cadaver. Although this is a temporary measure due to the inevitable biological rejection, it serves meanwhile to relieve pain, maintain body temperature, and decrease the patient's overall metabolic demand. • Cadaver skin grafts can be used to see if a burn wound is ready to accept the patient's own skin. If the homograft is rejected immediately, the wound is either infected or inadequately supplied with blood. It would be a terrible waste to use the patient's own precious little remaining skin only to have it be rejected. • Cadaver skin grafts can also be used to revitalize deep burn sites without good blood supply. In this case, superficial skin cells are removed from the dermis (the inner layer of skin) of the homograft, leaving only a meshlike framework of dermis. A few days after the framework is applied to the site, a very thin graft of epidermal (the outer layer) donor skin can be placed on top. Alternatively, the patient's own cells from unburned normal skin sites can be cultured in the lab and applied to the framework. As medical technology becomes ever-more advanced, there is greater use-as well as need-for the gift of skin. Scattered throughout the U.S., skin banks offer hope of recovery for burn victims of all races and ages-anyone who is fighting to survive life-threatening burns. As with other organ donations, post-mortem skin donations are processed quickly in order to avoid delay or disruption of funeral plans. The patches-no thicker than 15 one-thousandths of an inch-are taken from areas of the body hidden by clothing so they do not disfigure the donor. For more information about skin donation call the New York Firefighters Skin Bank at 212-746-7546. Or call the ASA office for the name and number of the skin bank closest to your city. ~Lloyd
A. Hoffman, MD., FACS
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