Glycerol preserved skin allograft - the key for the effective wound bed preparation

Abstract

Introduction: For spontaneous wound healing to occur, wound preparation must be optimised. This paper presents the authors’ experience and philosophy regarding wound bed preparation of extensive and complicated wounds. The properties of an ideal burn dressing can be summarized in four P’s: protection, proteolytic effect, promotion of healing, and pain relieving. Glycerol preserved skin allograft possess several key characteristics of an ideal wound bed preparation, including good adherence to the wound bed, water vapour transport, antimicrobial characteristics, low toxicity and antigenicity, ease of application and removal, a long shelf life, and minimal storage requirements. There are other benefits of skin allograft application, such as decreased loss of water, electrolytes, and proteins. Skin allograft application also reduces pain and thus allows for exercise and ambulation, also decreasing the incidence of contractures. Methods: This study included all patients with burns and complicated wounds, who were admitted to the Queen Fabiola Children’s University Hospital in Brussels from January 2010 to November 2010 who had been treated with a glycerol preserved allograft. After the removal of all devitalized tissue, angiogenesis of the wound bed is promoted by the temporary application of the glycerol preserved allograft (GPA). Results The results of the study showed the high effectiveness of these kinds of treatments: infection control, stimulation of angiogenesis, and granulation tissue formation. With the application of GPA, we ensured that even in the extreme age group patients, such as children, their wounds were optimised for the best chances of an allograft take at the first attempt. Otherwise, allograft failure may lead to the grave consequence of repeated allografting with further waste of the donor sites, wound infection, sepsis, or even mortality. Conclusion The preserved dermal layer, even if it is thin, is crucial for spontaneous wound healing with minimal hypertrophic scarring, due to the reduced inflammatory response in the wound bed, as observed in our patients.