Treating Burns with Autograft and Artificial Skin

treatment of burns

Treating Burns with Antimicrobial dressings can adversely affect wound healing, and require daily maintenance whereas Biological dressings have no direct toxins or antimicrobial properties. However, they do reduce loss of heat, water, protein and red blood cells, and promote more rapid wound healing.
Biological dressings also reduce burn wound pain.

These materials may be organic or synthetic in origin, but good wound adherence especially in 3rd degree burns is the key function.
Organic materials include, skin allograft from donors, autograft from the patient, pigskin (xenograft), homograft from cadavers, human amnion and  artificial skin covers including Biobrane© Op-site© and Omiderm©.

  • Autograft is usually only possible if the patient's burns are less than 70%, then the other alternatives for treating burns would be checked Autografts are taken from the thighs or buttocks where the resulting scars would be hidden. The thickness of the skin takes in the Epidermis and part of the Dermis, about the equivalent of 2nd Degree Burns, it is then put through a meshing machine which allows the skin to be expanded from 2 to 4 times it's original area. Healing of subsequent skin autograft can be expected in areas of good allograft 'take', thereby eliminating hypertrophic scarring
  • Fresh skin allograft has become the standard for temporary coverage of the clean open burn wound, it achieves an environmental 'seal' of the burn wound at the graft-wound interface and improves host immune defenses.

  • Homograft human skin graft can be obtained from fresh cadavers within 18 hours of death . The graft can re-vascularize once adhered to the wound., but rejection will occur within 14 days.
  • Allograft and Homograft provide the best temporary closure of the excised burn wound.and will undergo rejection in 7 to 14 days in normal patients.When peeled off, the underlying surface is granulated and heals up with minimal scarring.

  • Xenograft (pigskin) degenerates before it is rejected but provides the same level of protection from infection as allograft, so pigskin is often embedded with salts of antimicrobial agents to increase its bacteriostatic potential.Pigskin is cheaper and more available than allograft. Its recommended uses include protective coverage of partial-thickness wounds and should be changed every 3-4 days to prevent infection.

  • Artificial Skin dressings provide wound protection, increase the rate of wound healing, and reduce patient discomfort. Very careful application is essential. When used to cover clean partial-thickness wounds, the dressing detaches as healing occurs underneath.

Biobrane© is a synthetic, membrane with an outer silicone layer bonded to an inner collagen nylon matrix. Its elasticity and transparency allows easy drape ability, fuller range of movement and easy wound inspection.
The major problems with Biobrane© in treating burns are its expense and its lack of inherent antimicrobial properties. Wound infections are not uncommon.

In my particular case both Autograft and Homograft were used in treating burns. Autograft for my left hand, arm from wrist to shoulder, rib cage and neck, while Homograft was applied across the top of my chest.

The hand and arm were the first areas to be grafted with split skin Autografts taken from my thighs and were completely successful. The next stage was my upper arm and ribcage, but the site became infected with MRSA and the grafts didn't 'take' and just dropped off, making healing a much longer process, and leaving extensive hypertrophic scarring.

The Homograft across the chest took very well, but after a while became very smelly, unbearably so, and right under my nose, so I told the Doctor that I'd take them off myself and hide them in the dashboard of his car. He took them off right away, and the healing that had taken place under them was incredible, and has left very little scarring.

Other Methods for Treating Burns can be found in Sunburn Magazine.

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