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SKI N BANKI NG

Skin Banking is a process in which skin is removed from a donor body, tested for suitability as a graft
material, packaged, stored, and finally reused as a graft. The process is similar to that for blood banking.
Skin grafts can be autografts or allografts.
An autograft is tissue which is removed from and then used on the same individual. Auto-skin grafts can
be used as a treatment for 2nd and 3rd degree burns and for reconstructive surgery. Skin autografts are
permanent replacement grafts and will heal full thickness burn wounds. Autografting requires that skin be
removed from a "donor site". Autografts involve the removal the epidermis and some of the dermis but are
not deep enough to remove the hair follicles and glands. Therefore, the epidermal cells within the hair
follicles and glands can regenerate (grow) a new epidermis over the donor site while the skin graft
provides a new epidermis and some dermis to the wound it covers. Because autografts are thin and
usually don't contain hair follicles or glands, the grafted areas will be devoid of hair and unable to sweat.
Allografts are tissue that is removed from one individual and used on a different individual. Allograft skin
is used as a temporary burn wound graft and will be rejected by the recipient, usually within 7-21 days.
Until rejection, however, allograft skin will provide many of the functions of healthy skin. Skin allografts will
close a wound providing a barrier against infection and fluid loss, decrease pain, and promote healing of
underlying tissues. Skin allografts are use as a transitional treatment until autografting can permanently
close the burn wound. Allograft skin is obtained from cadaveric (deceased) donors after consent is
obtained from the next-of-kin. Tissue donors are carefully screened by reviewing past and present
medical records, interviewing medical staff, interviewing the next-of-kin for past medical history and high
risk lifestyles. Samples of the donor's blood are also tested for many transmissible diseases including
hepatitis and AIDS.
Allograft skin may be used fresh or frozen. Fresh skin allografts are considered by some to be more
desirable because they are more viable (alive) than frozen grafts. Others feel that viability is unimportant
because the grafts are only temporary. Fresh skin grafts are maintained in a fluid medium intended to
keep the cells alive and nourished. Fresh storage will only maintain skin grafts for approximately 14 days.
It may take upwards of 10 days to release tissue from quarantine due to bacterial and serologic testing
therefore, most skin banks freeze their tissue grafts. Freezing skin grafts involves soaking the tissue in
special medium (cryoprotectants) and then freezing the tissue grafts in a controlled environment.
Cryoprotectants are intended to minimize the freezing injury to cells. Most tissues are control-rate frozen
at 1-5 degrees Centigrade per minute and then stored at ultra-low temperatures (below -60 C). Frozen
grafts can have a shelf life of up to five years.

What Is a Homograft Skin Graft?
A homograft skin graft is a transplanted tissue that is from a donor of the same species
but of a different genetic constitution. The transplant may also be of an organ, the
procedure is highly technical and requires a qualified surgeon to conduct. For the
procedure to take place, the donor should have basic matches to the patient e.g, the
blood types should match.

What Is a Skin Graft?
A skin graft is a surgical procedure that involves removing skin from one part of your body (the
donor site) and moving it, or transplanting it, to a different part. This surgery may be done if part
of your body has lost its protective covering of skin due to injury or illness.
Skin grafts are performed in a hospital. Most skin grafts are performed using general anesthesia,
which means that you will sleep painlessly throughout the procedure.
Part 2 of 6: Reasons
Reasons for Skin Grafts
A skin graft is placed over an area of the body where the skin has been lost. Some common
reasons for skin grafts include:
skin infections
deep burns
large, open wounds
bed sores or other ulcers on the skin that dont heal well
Part 3 of 6: Types
Types of Skin Grafts
There are two basic types of skin grafts: split-level thickness and full thickness.
Split-Level Thickness Grafts
A split-level thickness graft involves removing only the top two levels of the skinthe
epidermis and the dermisfrom the donor site. These grafts are used to cover large areas. Split-
level grafts tend to be fragile and have a shiny or smooth appearance. They may also appear
paler than the adjoining skin. Because they do not grow with the rest of the skin, a child who
receives a split-level graft may need additional grafts as he or she gets older.
Full-Thickness Grafts
A full thickness graft involves removing the muscles and blood vessels as well as the top layers
of skin from the donor site. Full-thickness grafts are generally used for small wounds on a highly
visible part of the body, such as the face. Unlike split-level thickness grafts, they blend in well
with the skin around them and usually grow with the individual.
Part 4 of 6: Preparation
Skin Graft Preparation
Most doctors schedule skin grafts several weeks in advance so that you have time to plan for the
surgery. You may need to stop taking certain medications, such as aspirin, that interfere with the
bloods ability to form clots.
You should minimize stair climbing immediately after the surgery and plan to have someone to
stay with you to help take care of you during your first few days at home.
Your doctor will tell you not to eat or drink anything after midnight on the day of the surgery.
Part 5 of 6: Procedure
Skin Graft Procedure
You will arrive at the hospital on the morning of the surgery. A nurse or a technician will help
you get ready for the operation by giving you a hospital gown to wear in place of street clothes
and starting an IV in your hand, arm, or wrist. The IV allows your doctors to give you medicine
and fluids during and after the surgery.
When it is time for your operation, you will be taken into the operating room. Once you are in
the operating room, a doctor will inject a medicine into your IV line. The medicine, called
general anesthetic, will make you fall asleep and stay asleep throughout the surgery so that you
dont feel any pain.
The surgeon will begin the operation by removing skin from the donor site. If you are getting a
split-level thickness graft, the skin will be removed from an area of your body that is usually
hidden by clothes, such as your hip or the inside of your thigh. If you are getting a full-thickness
graft, the preferred donor sites are the abdominal wall or the chest wall.
Once the skin is removed from the donor site, the surgeon carefully places it over the transplant
area and fixes it in place with a surgical dressing, staples, or stitches. He or she will also cover
the donor area with a dressing that wont stick to the wound.
Part 6 of 6: Aftercare
Aftercare for a Skin Graft
You will wake up in the recovery room. The staff will watch you closely after surgery,
monitoring your vital signs and giving you medications to manage pain. When the staff is sure
you are stable, you will be taken to a hospital room to continue your recovery.
If you have had a split-level thickness graft, your doctor will probably want you to stay in the
hospital for a few days to make sure that both the graft and the donor site are healing well. The
graft should start developing blood vessels to connect it with the skin around it within 36 hours.
If these blood vessels do not begin to form, it could be a sign that your body is rejecting the graft.
You may hear doctors say that the graft hasnt taken. If the graft doesnt take, you may require
another operation and a new graft.
A full-thickness graft usually requires a hospitalization of about one to two weeks. You may also
require rehabilitation, such as physical or occupational therapy, as you heal.
Your doctor will probably discharge you with a prescription for painkillers and instructions
about how to care for the graft site and the donor site to avoid infection.
Avoid activities that stretch or pull the graft site for at least three to four weeks. The donor site
will heal within two to three weeks. Your doctor will tell you when it is safe to resume your
normal activities.
Your skin is the largest organ in your body. It's also one of the most important. Why? Your skin performs
essential functions like temperature regulation, hydration and protection against invadingbacteria. If you
fall on your bike and scrape away a thin layer of skin, the boo-boo will heal on its own. Unfortunately, the
regenerative power of skin is no match for the hellish fury of fire.
The pain of a severe burn is almost unimaginable -- and so is the destruction it causes. Simply put, your
body won't last very long without the skin's protection. Large, open wounds are highly susceptible to
bacterial infections and if the body can't regulate its temperature and hydration, it will go into shock. For
decades, the best treatment option for a severe burn has been a skin graft.
Skin grafts sound like something straight out of a medieval torture manual, but they save hundreds of
thousands of lives every year. More than two million people in the United States require treatment for
burns every year and between three and four thousand die from their injuries [source: Merck Manual].
To perform a skin graft, surgeons remove healthy skin from a patient's body and attach it to the wounded
area. Extensive scarring is inevitable and the healing process can be long and painful, but the majority of
patients will survive the treatment and return to their normal lives.
What are the injuries and conditions that require a skin graft? How is the surgery performed? And what
are the latest breakthroughs in artificial skin technology? Keep reading to find out more.

Types of Skin Grafts
In all skin graft procedures, skin must be removed from a donor site and attached to the wounded area.
The preferred source of the donor skin is the patient himself. This procedure is called an autograft. Since
the body's immune system will ultimately reject foreign skin, autografts are the best option for long-term
treatment.
In some cases, the patient might be too sick or injured for doctors to immediately perform an autograft. In
that case, doctors may place a temporary skin covering on the affected area to cut down on the chance of
infection and buy time until the patient regains his or her strength.
When skin is used from another human (usually a cadaver), it's called an allograft. Allografts can last
seven to ten days before the body rejects them [source: WCI]. Xenografts are temporary skin coverings
harvested from animals, usually pigs. They only last three to five days [source: BCM]. In some cases, the
injury is superficial enough that the patient doesn't need an autograft. The allograft or xenograft can
provide enough protection to allow the skin to regenerate on its own.
In cases where an autograft is necessary, there are three major types to choose from: split-thickness
grafts, full-thickness grafts and composite grafts. The main criteria for choosing which method to use is
the depth of the patient's skin loss. Split-thickness grafts are for the shallowest wounds, or those that
affect only the epidermis and part of the dermis. They are called split-thickness grafts because the doctor
removes only a few layers of skin from the donor site.
Full-thickness grafts require that all three skin layers -- epidermis, dermis and hypodermis -- be
removed from the donor site. Full-thickness grafts are often used in cases where the cosmetic
appearance of the injured area is very important, like the face. Full-thickness grafts include hair follicles,
sweat glands and blood vessels that allow the graft area to look and function more normally. Split
thickness grafts, since they lack underlying glands and blood vessels, tend to look flat and discolored.
A composite graft is for wounds that include bone, tendon, cartilage or the loss of muscle. In the case of
a nose reconstruction, for example, the surgeon would need to harvest a composite graft that includes
supportive cartilage tissue along with the skin layers.
An exciting new alternative to autografts is lab-generated skin, but we'll talk more about that later. Right
now, we're going to walk through the difficult skin graft surgical procedure.

Skin Graft Surgery
For most skin graft procedures, the patient is put under general anesthesia. But if the affected area is
very small, the doctor can use a local anesthetic to relieve pain.
The first step is to debride the wound area. In this procedure, the surgeon will meticulously clean the
wound area to remove any damaged skin and tissue. He may need to use a scalpel to cut away uneven
tissue along the edge of the wound. The goal is to create a clean, disinfected and bleeding surface on
which to attach the donor skin.
Next, the surgeon measures the precise area of the wound and traces the identical pattern over the donor
site. The donor site can be anywhere on the body, but surgeons usually choose spots that are covered by
clothing like the lower back, buttock or inner thigh [source: Medline Plus]
To remove the exact thickness of skin from the donor site, the surgeon uses a special tool called
adermatome. Even though it's a nauseating image, think of a dermatome like a surgical-grade cheese
slicer.
To maximize the effectiveness of a minimum amount of donor skin, doctors may choose to mesh the
donor skin. To do this, doctors pass the harvested skin layers through a rolling device (resembling an old
mimeograph machine) that perforates the skin with hundreds of tiny holes. The result looks like a mesh T-
shirt. The surgeon can now stretch the meshed skin to cover a larger wound area. Mesh skin also allows
the underlying wound to easily excrete fluids, lessening the risk of infection.
In most cases, the donor skin is placed carefully over the wound and fastened with stitches or surgical
staples. For very thin split thickness grafts, it's possible to forgo stitches and simply secure the graft with
gauze and dressing. For full-thickness grafts, the graft area will be covered with an antibiotic solution,
several layers of mesh gauze as well as extra bandages, elastic netting and even a cast.
The donor site will also require treatment. In the case of a full-thickness graft, the donor site will need to
be stitched back together. Split-thickness grafts usually only require lots of antibiotic ointment and clean
dressing to regenerate new skin layers.
Skin grafts take time to heal -- this applies to both the donor site and the graft area. And unfortunately,
grafts don't always work the first time. Read more about the healing process and possible complications
on the next page.

Healing and Complications of Skin Grafts
Skin cannot survive without oxygen. The best way to infuse skin cells with oxygen and other nutrients is
through the blood. Healthy, living skin is full of tiny blood vessels that channel the body's blood supply to
grow new skin cells and sustain older ones.
For a skin graft to heal, it must grow and activate new blood vessels. In a successful graft, this
regeneration process begins as quickly as 36 hours after surgery [source: Medline Plus].
Because oxygen is so important to the healing process, some doctors prescribe hyperbaric
oxygen therapy. Perhaps you've heard of a hyperbaric chamber. It looks like a long, glass-walled tube
surrounding a raised bed. Inside a hyperbaric chamber, the patient is exposed to a 100 percent oxygen
environment at twice the normal atmospheric pressure. These intense blasts of pure oxygen can speed
the healing process of skin grafts.
Another healing technique is something called vacuum-assisted closure (VAC). In this post-operative
procedure, the grafted skin is dressed with a porous bandage and attached to a tube that connects to a
vacuum source. The vacuum helps draw out interstitial fluids and encourage blood flow to the graft. All
potentially infectious fluids are sucked out of the wound for easy disposal. Some surgeons are so
impressed with the technique that they leave the VAC tube attached for up to seven days after surgery
without even changing the dressing [source: Carson].
The healing process for skin grafts can be slow, depending on the severity of the wound and the size and
depth of the donor sites. Patients who receive full-thickness grafts may need to stay in the hospital for as
long as two weeks to keep the graft stabilized and infection-free. Split-thickness grafts may only require a
few nights at the hospital.
In all cases, patients will have to be very gentle with their graft areas when they get home. They should
avoid stretching the skin and abstain from vigorous physical activity for at least a month. Remember that
the donor site may take a couple a weeks to heal, too.
All skin grafts leave scars, both in the donor site area and the graft itself. Full-thickness grafts leave a less
noticeable scar, because they contain functional blood vessels. Split-thickness grafts, which lack sweat
glands, hair follicles and blood vessels, are discolored and need to be moisturized frequently to avoid
scaling and chafing.
Unfortunately, some skin grafts can form infections in the area between the donor skin and the wound.
Fluid can build up underneath the donor skin, preventing it from successfully attaching to the wound site.
In these cases, the graft is said to "fail," and will need to be reattempted with a new batch of donor skin.
All in all, skin grafts can be painful, difficult procedures. The good news is that medical researchers have
developed artificial skin products to minimize the use of donor skin and speed the healing process. Read
more about lab-grown skin on the next page

Allograft: Cadaver Bone from a Tissue Bank
Allograft is bone harvested by a tissue bank from a cadaver for use in medical procedures. It can be
prepared in a number of different forms (such as chips) for use in a spine fusion.
While allograft bone only provides a calcium scaffolding, does not have any bone-growing cells or bone-
growing proteins required to stimulate new bone growth, and thus has a lower chance of fusion as
compared to using the patient's bone, it has proven comparable in certain studies to autograft in terms of
producing successful fusions.
3, 4, 5

Uses of Allograft Bone
Allograft bone may be used either on its own or as a supplement to the patients own bone.
Allograft used on its own. In the lumbar spine, allograft bone is restricted for use in ALIF or PLIF procedures
in which bone graft is placed in compression between the vertebrae, as the compression fosters a better healing
process for the bone. In a posterolateral gutter spine fusion, in which the bone is placed in tension, allograft bone
by itself is not likely to result in a solid fusion.