The Use of Allograft Skin in Burn Surgery

The skin is the largest organ in the human body and has a number of vital protective and homeostatic functions. Major burn injury often requires multidisciplinary care in an intensive care setting, multiple surgical procedures to achieve wound healing followed by prolonged rehabilitation and possibly a lifetime of reconstructive procedures to achieve psychosocial, aesthetic and functional recovery. The removal of dead or devitalized tissue saves lives, improves form and optimizes function. Once the devitalized tissue is removed wound closure must be achieved either with autologous skin or a temporary or permanent skin substitute. Physiological closure of the burn wound reduces invasive infection, evaporative water loss, heat loss, pain and promotes wound healing. Human deceased donor allograft skin has many of the properties of an ideal biological dressing and represents the best alternative when autologous skin is not available for temporary wound closure. Synthetic skin substitutes can be temporary or permanent and are used to replace the epidermal portion of the skin, the dermal portion or both. Future research and development will lead to skin substitutes becoming cheaper, readily available, more reliable and increasingly sophisticated.