scholarly journals Procurement and Use of Cryopreserved Total Skin Allograft in Complex Wounds

2021 ◽  
Author(s):  
Marcelo Fonseca ◽  
Aldo Cañete ◽  
Dino Ibaceta ◽  
Catalina Buchroithner ◽  
Florencia Disi ◽  
...  
Keyword(s):  
Skin Allograft ◽  
Therapeutic Alternative ◽  
Alternative Option ◽  
Skin Allografts ◽  
Dermal Regeneration ◽  
Complex Wounds

Cryopreserved total skin allografts are a new therapeutic alternative for the management of complex wounds. Their properties allow them to be classified as a temporary coverage for some patients and as definitive in others. And they can be an alternative option to the use of dermal regeneration templates.

scholarly journals Deceased donor skin allograft banking: Response and utilization

2010 ◽  
Vol 43 (S 01) ◽  
pp. S114-S120
Author(s):  
Madhuri A. Gore ◽  
Anuradha S. De
Keyword(s):  
Burn Injury ◽  
Deceased Donor ◽  
Indian Society ◽  
Skin Substitutes ◽  
Skin Allograft ◽  
Medical College ◽  
Skin Allografts ◽  
Donor Skin ◽  
Life Saving ◽  
Feasible Option

ABSTRACT Background: In the absence of xenograft and biosynthetic skin substitutes, deceased donor skin allografts is a feasible option for saving life of patient with extensive burn injury in our country. Aims: The first deceased donor skin allograft bank in India became functional at Lokmanya Tilak Municipal (LTM) medical college and hospital on 24th April 2000. The response of Indian society to this new concept of skin donation after death and the pattern of utilization of banked allografts from 2000 to 2010 has been presented in this study. Settings and Design: This allograft skin bank was established by the department of surgery. The departments of surgery and microbiology share the responsibility of smooth functioning of the bank. Materials and Methods: The response in terms of number of donations and the profile of donors was analyzed from records. Pattern and outcome of allograft utilization was studied from specially designed forms. Results: During these ten years, 262 deceased donor skin allograft donations were received. The response showed significant improvement after counselling was extended to the community. Majority of the donors were above 70 years of age and procurement was done at home for most. Skin allografts from 249 donors were used for 165 patients in ten years. The outcome was encouraging with seven deaths in 151 recipients with burn injuries. Conclusions: Our experience shows that the Indian society is ready to accept the concept of skin donation after death. Use of skin allografts is life saving for large burns. We need to prepare guidelines for the establishment of more skin banks in the country.

scholarly journals Treg-mediated prolonged survival of skin allografts without immunosuppression

2019 ◽  
Vol 116 (27) ◽  
pp. 13508-13516 ◽  
Author(s):  
Nina Pilat ◽  
Mario Wiletel ◽  
Anna M. Weijler ◽  
Romy Steiner ◽  
Benedikt Mahr ◽  
...  
Keyword(s):  
Graft Survival ◽  
Skin Graft ◽  
Interleukin 2 ◽  
Tolerance Induction ◽  
Allograft Survival ◽  
Skin Allograft ◽  
Skin Allografts

Injection of Interleukin-2 (IL-2) complexed with a particular anti–IL-2 monoclonal antibody (mab) JES6-1 has been shown to selectively expand CD4+Foxp3+ T regulatory T cells (Tregs) in vivo. Although the potency of this approach with regard to transplantation has already been proven in an islet transplantation model, skin graft survival could not be prolonged. Since the latter is relevant to human allograft survival, we sought to improve the efficiency of IL-2 complex (cplx) treatment for skin allograft survival in a stringent murine skin graft model. Here, we show that combining low doses of IL-2 cplxs with rapamycin and blockade of the inflammatory cytokine IL-6 leads to long-term (>75 d) survival of major histocompatibility complex-different skin allografts without the need for immunosuppression. Allograft survival was critically dependent on CD25+FoxP3+ Tregs and was not accompanied by impaired responsiveness toward donor alloantigens in vitro after IL-2 cplx treatment was stopped. Furthermore, second donor-type skin grafts were rejected and provoked rejection of the primary graft, suggesting that operational tolerance is not systemic but restricted to the graft. These findings plus the lack of donor-specific antibody formation imply that prolonged graft survival was largely a reflection of immunological ignorance. The results may represent a potentially clinically translatable strategy for the development of protocols for tolerance induction.

scholarly journals Increased frequency of myeloid-derived suppressor cells facilitating skin allograft survival in aged mice

2020 ◽  
Author(s):  
Weichen Lee ◽  
Yu-Chao Wang ◽  
Hsiu-Ying Hsu ◽  
Pao-Yueh Hsu ◽  
Chih-Hsien Cheng ◽  
...  
Keyword(s):  
T Cells ◽  
Regulatory T Cells ◽  
Immunosuppressive Agents ◽  
Suppressor Cells ◽  
Myeloid Derived Suppressor Cells ◽  
Aging Effects ◽  
Skin Allograft ◽  
Aged Mice ◽  
Skin Allografts ◽  
Young Mice

Abstract Background More and more aged people have organ transplantation recently. Aging process may have an influence on immunity, which conducts an adjustment of immunosuppressive agents to prevent adverse effects. Understanding of aging effects on immunity will be helpful for post-transplant care of aged recipients. Results A mouse model using C3H mice as donors and aged/young C57BL/10J mice as recipients was employed to study the aging effects on immunity. The frequency of CD4 + , CD8 + and native CD4 + foxp3 + regulatory T-cells in the spleen were not different between aged and young mice. However, the frequency of CD11b + Gr-1 + myeloid-derived suppressor cells (MDSC) was higher in aged mice (4.4 ± 1.4% versus 1.6 ± 1.1%, p=0.026). To measure cytokines in the serum, the level of TGF-β was higher in aged mice than in young mice (21.04 ± 3.91ng/ml versus 15.26 ± 5.01ng/ml, p = 0.026). In vitro, enriched T-cells from aged mice had lower proliferation capacity (0.350±0.003 O.D. versus 0.430±0.017 O.D. at responders/stimulatory cells = 100/1) and lower Ag-specific cytotoxic ability (21.2 ± 3.0% versus 39.3 ± 4.8% at target cell/effector cells = 1/100, p=0.003) than T-cells from young mice. In vivo, the skin allografts survived on aged recipients was 19.7 ± 5.2 days, compared 11.9 ± 4.1 days on young mice (p = 0.005). When entinostat was applied to aged mice to block MDSC, the survival of skin allografts was shorten to 13.5 ± 4.7 days which was not different from the survival on young mice (p = 0.359). Conclusion The allogeneic immunity was lower in aged than in young mice evidenced by a higher frequency of MDSC, higher serum level of TGF-β, decreased function of T-cells, and easy-to-induced regulatory T-cells in aged mice. Blocking the function of MDSC reversed the low immunity in aged mice and cause skin allograft rejection similar to young recipients.

scholarly journals The versatility of a glycerol-preserved skin allograft as an adjunctive treatment to free flap reconstruction

2009 ◽  
Vol 42 (01) ◽  
pp. 094-099 ◽  
Author(s):  
A. Z. Mat Saad ◽  
T. L. Khoo ◽  
A. A. Dorai ◽  
A. S. Halim
Keyword(s):  
Free Flap ◽  
Antimicrobial Properties ◽  
Case Series ◽  
Free Tissue Transfer ◽  
Adjunctive Treatment ◽  
Flap Surgery ◽  
Skin Allograft ◽  
Skin Allografts ◽  
Free Flap Surgery ◽  
Unique Composition

ABSTRACTSkin allografts have been used in medical practice for over a century owing to their unique composition as a biological dressing. Skin allografts can be obtained in several preparations such as cryopreserved, glycerol-preserved, and fresh allograft. A glycerol-preserved allograft (GPA) was introduced in the early 1980s. It has several advantages compared with other dressings such as ease of processing, storage and transport, lower cost, less antigenicity, antimicrobial properties, and neo-vascularisation promoting properties. Skin allografts are mainly used in the management of severe burn injuries, chronic ulcers, and complex, traumatic wounds. Published reports of the use of skin allografts in association with free flap surgery are few or non existent. We would like to share our experience of several cases of free tissue transfer that utilised GPA as a temporary wound dressing in multiple scenarios. On the basis of this case series, we would like to recommend that a GPA be used as a temporary dressing in conjunction with free flap surgery when required to protect the flap pedicle, allowing time for the edema to subside and the wound can then be closed for a better aesthetic outcome.

scholarly journals Rejection of first-set skin allografts in man. the microvasculature is the critical target of the immune response.

1979 ◽  
Vol 150 (2) ◽  
pp. 322-337 ◽  
Author(s):  
H F Dvorak ◽  
M C Mihm ◽  
A M Dvorak ◽  
B A Barnes ◽  
E J Manseau ◽  
...  
Keyword(s):  
Immune Response ◽  
Allograft Rejection ◽  
Cellular Immune Response ◽  
Delayed Hypersensitivity ◽  
Skin Allograft ◽  
Microvascular Endothelium ◽  
Microvascular Damage ◽  
Microvascular Injury ◽  
Skin Allografts ◽  
Cellular Immune

Recent reports of microvascular injury in delayed hypersensitivity skin reactions prompted us to reexamine the pathogenesis of first-set skin allograft rejection in man using morphologic techniques that allowed both extensive vessel sampling and unequivocal evaluation of microvascular endothelium. We here report that widespread microvascular damage is a characteristic, early consequence of the cellular immune response to first-set human skin allografts and is qualitatively similar to, but substantially more extensive than, that occurring in delayed hypersensitivity reactions. Microvascular damage in invariably preceded significant epithelial necrosis and affected initially and primarily those venules, arterioles, and small veins enveloped by lymphocytes. Vessels of both the allograft itself and the underlying graft bed (recipient tissue) were equally affected. These data suggest that endothelial cells of the microvasculature are the critical target of the immune response in first-set vascularized skin allograft rejection in man and that rejection can be attributed largely to ischemic infarction resulting from extensive microvascular damage. Other mechanisms, such as direct cellular contacts between infiltrating lymphocytes and epithelium, apparently played only a minor role. The findings presented here indicate that the rejection of first-set vascularized skin allografts, though induced by immunologically specific mechanisms, is primarily effected by final pathways that are relatively nonspecific and that may cause damage to both foreign and host vessels and cells. Rather than contradicting studies demonstrating the exquisite specificity of allograft rejection in other systems, these findings provide a further example of the heterogeneity of the cellular immune response. Recognition of the critical role of immunologically mediated microvascular injury may prove important both for an understanding of the biology of allograft rejection and for strategies aimed at prolonging allograft survival.

scholarly journals Lack of Peripherally Induced Tolerance to Established Skin Allografts in Immunologically ReconstitutedScidMice

1992 ◽  
Vol 3 (1) ◽  
pp. 45-50 ◽  
Author(s):  
T. V. Rajan ◽  
Leonard D. Shultz ◽  
Dale L. Greinert
Keyword(s):  
Immune System ◽  
Fetal Liver ◽  
Present Report ◽  
Model System ◽  
Scid Mice ◽  
Peripheral Tolerance ◽  
Skin Grafts ◽  
Skin Allograft ◽  
Clonal Deletion ◽  
Skin Allografts

The mechanism by which the antigen-specific immune system distinguishes between foreign antigens (toward which it mounts an immune response) and self-antigens (of which it is tolerant) is not completely understood. Studies using “superantigens” and transgenic mice have allowed investigations into some of the mechanisms of clonal deletion, anergy, and peripheral tolerance. In the present report, we have attempted to develop a new model system to investigate the possible mechanism(s) of peripheral tolerance to allografts. In this system, skin grafts from C57BL/6J (B6;H-2bmice are grafted onto T- and B-lymphocyte-deficient C.B-17-scid/scid(H-2d; hereafter referred to asscid) mice. Because of their lack of functional lymphocytes, thescidmice readily accept the allogeneic skin grafts. After the allografts healed, the scid mice were reconstituted with T-cell-deficient fetal liver from coisogeneic C.B-17-∤/∤ mice or bone marrow from weanling congenitally athymic BALB/c-nu/nu(H-2d; hereafter referred to asnude) mice. Upon immunological reconstitution, the scid mice reiected the established B6 skin allografts, suggesting that an immune system developing in the presence of an intact peripheral skin allograft fails to develop tolerance to the peripheral allograft. This model system may be useful for the study of the mechanisms required for the induction of peripheral tolerance.

scholarly journals Zoledronic acid, an aminobisphosphonate, prolongs survival of skin allografts

2012 ◽  
Vol 35 (4) ◽  
pp. 165 ◽  
Author(s):  
Chia-Yuan Liu ◽  
Po-Sheng Yang ◽  
Shih-Ping Cheng ◽  
Yu-Chuen Huang ◽  
Jie-Jen Lee ◽  
...  
Keyword(s):  
Body Weight ◽  
Zoledronic Acid ◽  
Mononuclear Cells ◽  
Leukocyte Count ◽  
Control Group ◽  
Allograft Survival ◽  
Skin Allograft ◽  
Skin Allografts ◽  
Major Toxicity ◽  
And Control

Purpose: Zoledronic acid (ZOL), an effective nitrogen-containing bisphosphonate used to prevent excessive bone loss in clinical practice, has been shown to affect the development of dendritic cells by redirecting differentiation toward a state of atypical maturation. The study was aimed to examine whether ZOL can reduce acute rejection of skin allografts. Methods: A skin transplantation model using C57BL/6 to BALB/c mice was used. ZOL was injected intraperitoneally into transplant recipients post-surgically. Graft survival, body weight, leukocyte count, hepatic and renal functions were assessed. Results: ZOL treatment significantly prolonged skin allograft survival in mice. In terms of toxicity, there were no significant differences in body weight, leukocyte count, plasma alanine aminotransferase or creatinine levels between the ZOL-treated and control groups. Histopathology showed that the loss of skin integrity seen in control group was prevented by ZOL treatment. In draining lymph nodes and spleen, the number and clustering extent of mononuclear cells were markedly declined by ZOL treatment. The plasma IL-6 levels were reduced by treatment of ZOL. Conclusion: ZOL can prolong skin allograft survival without major toxicity.

The role of Integra dermal regeneration matrix in skin replacement on the upper extremity

2012 ◽  
Vol 153 (34) ◽  
pp. 1351-1355 ◽  
Author(s):  
Csaba Halmy ◽  
Zoltán Nádai ◽  
Gergely Tamás ◽  
Tamás Kassai ◽  
Róbert Tamás
Keyword(s):  
Skin Grafting ◽  
Upper Extremities ◽  
Dermal Regeneration Template ◽  
Skin Replacement ◽  
Male Patients ◽  
Dermal Regeneration ◽  
Skin Coverage ◽  
Complex Wounds ◽  
Grafting Onto

Authors report the application of Integra dermal regeneration matrix in 10 patients in 12 indications (ages 25–74 years, 6 female and 4 male patients). The smallest reconstructed area was 6 cm2, the largest was 500 cm2. Skin coverage was needed on the lower arm in two patients, on the lower arm and the hand in two patients and on the hand in six patients. Skin grafting onto the neodermis was made on days 19–25. The take rate of Integra was equal or higher than 97%, and the take rate of the skin graft was equal or higher than 90%. Integra dermal regeneration template proved to be suitable for the management of complex wounds on the hands and upper extremities. Orv. Hetil., 2012, 153, 1351–1355.

scholarly journals Rejection of skin allografts by indirect allorecognition of donor class I major histocompatibility complex peptides.

1992 ◽  
Vol 175 (6) ◽  
pp. 1521-1529 ◽  
Author(s):  
J Fangmann ◽  
R Dalchau ◽  
J W Fabre
Keyword(s):  
Allograft Rejection ◽  
Class I ◽  
Skin Allograft ◽  
Classical Class ◽  
Skin Allografts ◽  
Indirect Allorecognition ◽  
Domain Peptide ◽  
Antigen Presenting ◽  
Direct Recognition ◽  
Helical Region

LEW (RT1l) rats were immunized with peptides corresponding to the alpha helical region of the alpha 1 domain (peptide 1), the beta sheet of the alpha 2 domain (peptide 2), and the alpha helical region of the alpha 2 domain (peptide 3) of the RT1-Aav1 classical class I molecule of the DA (RT1av1) strain. The immunizations were without carriers, and the objective was to prime to indirect allorecognition without influencing direct recognition of the RT1-Aav1 molecule. The LEW rats mounted strong primary and secondary antibody responses to peptides 1 and 3, but only weak secondary responses to peptide 2. None of the antipeptide antibodies crossreacted with intact RT1-Aav1 class I molecules. The immunization also resulted in LEW antigen-presenting cell-dependent, CD4+ T cell proliferative responses, which were very strong against peptide 1 and weakest against peptide 2. LEW rats immunized with peptides 1 or 3, but most effectively with both peptides 1 and 3 together, showed accelerated rejection of DA skin allografts. This effect was not observed in LEW rats immunized with peptide 2. In response to the DA skin allograft, the peptide-immunized LEW rats showed markedly accelerated kinetics of antibody production to the intact RT1-Aav1 molecule. These data demonstrate that indirect allorecognition can play an important role in allograft rejection and have important implications for understanding allograft rejection and its regulation.

Sign in / Sign up

Export Citation Format

Share Document