Skin banks serve as an important resource for the Plastic and Reconstructive Surgeon. This is especially true for the developing countries, where skin substitutes are not readily available. Skin banks became a possibility only when tissue preservation techniques improved in the middle of the twentieth century. The first recognized skin bank was set up in 1949 by the U.S. Navy. Since then they have been used mainly by Plastic and Reconstructive Surgeons, all over the world.
The donor skin grafts act as a biological, physiological treatment. They promote re-epithelization, shorten healing time and alleviate pain. They also protect dermal and subcutaneous structures such as cartilage, tendons, bones and nerves. In the western countries, a variety of skin substitutes and matrices are available, which makes the skin banks less crucial. In our country, however, there are few alternatives. This is especially true for extensive burns, traumatic wounds and when the tendons, nerves, bones or other vital structures are exposed.
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The skin is procured carefully from fresh cadavers under strict aseptic conditions. The skin is then taken to skin banks and stored under strict sepsis and temperature control. The Banks are heavily regulated both in Europe, and the U. S. testing is mandatory for several diseases including HIV, Hepatitis C and B as well as syphilis. Other microbiological tests to prevent infection are also necessary. The preservation time needs to be kept brief for viability of tissues.
The most important use of skin banks is for the treatment of acute burns. The donor skin serves as a biological dressing and prevents fluid and electrolyte loss, which is one of the most common causes of early death in burns. The skin also helps in preventing infection, which can lead to sepsis and death. It helps in epithelialization and decreases deformity. Most importantly, it buys time until skin grafts can be obtained from the patient and improve outcomes.
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In the trauma units, the skin bank provides skin to cover vital structures and prevents desiccation. When the final reconstruction is done, the results are significantly better. In chronic wounds, the donor skin grafts can promote healing. This is important for pressure ulcers, venous ulcers, diabetic wounds, as well as radiation-induced wounds.
The process of obtaining the grafts as well as the application of these grafts is straightforward. Tissue banks especially skin banks, have become invaluable as a part of a Plastic Surgeons armamentarium both for acute burns and wounds as well as for chronic, nonhealing wounds.
About The Author: Dr Ajaya Kashyap is a Sr. Consultant, Plastic & Reconstructive Surgery at Fortis La Femme, New Delhi
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