title: The Israel National Skin Bank: Quality Assurance and Graft Performance of Stored Tissues.
abstract: The Israel National Skin Bank (INSB) was founded jointly by the Israel Defense Forces (IDF) Medical Corps and the Ministry of Health in 1986. The prime purpose of the Skin Bank is to treat burn victims incurred at war or during mass casualty incidences. The INSB Protocol is comprised of international skin bank protocols and our previous and present research results. They provide the framework for selecting optimal guidelines for procurement, processing, preservation, storage and evaluation of transplantation performance of viable skin grafts. For evaluation and direct comparison of graft performance of glycerolized or cryopreserved skin stored for long periods, we have applied a mouse recipient model developed by us. This model assesses graft performance before the rejection process takes place. The in vivo design has inherent clinical relevance, which is especially appealing. Cryopreserved skin performed better than glycerolized skin (p > 0.027), but fresh skin performed significantly better than cryopreserved skin (p > 0.003), as analyzed by the Mann-Whitney non-parametric test. Then graft performance of skin specimens were cryopreserved by programmed or stepwise freezing and stored at -80 degrees C or in liquid nitrogen for 1 and 6-10 months was evaluated. The average score of skin preserved by programmed freezing and stored in liquid nitrogen is the highest for both storage periods. This method has a highly significant advantage (p < 0.007) over the others for 6-10 months storage, evaluated by graft adherence. Several interaction factors determine the quality of cryopreserved skin. Highly significant is the interaction factor/'combined effect' of sample variability with the method of cryopreservation or with the storage period. Finally, the results of paired comparison of selected histology criteria of cryopreserved to fresh skin indicated that storage of skin for up to 5 years did not impair significantly its performance compared to fresh skin, whereas, after six years of storage, there was a highly significant (p < 0.001) impairment in skin quality. We offer a simplified in vivo model and analysis for cryopreserved skin graft performance, suggesting that the evaluation procedures, which are issues of great interest in skin banking, may help future skin banks to make informed choices and decisions regarding quality issues.
authors.affiliation: The Laboratory of Experimental Surgery Hadassah University Hospital, Jerusalem, Israel; The Israel National Skin Bank Hadassah University Hospital, Jerusalem, Israel; Author for correspondence: Experimental Surgery, Hadassah University Hospital, P.O.B. 12000, Jerusalem 91120, Israel (Tel.: 972-2-6758129; Fax: 972-2-6757132; E-mail: benbassat@hadassah.org.il)
authors.forename: H.
authors.initials: H
authors.lastname: Ben-Bassat
authors.forename: M.
authors.initials: M
authors.lastname: Chaouat
authors.forename: E.
authors.initials: E
authors.lastname: Zumai
authors.forename: N.
authors.initials: N
authors.lastname: Segal
authors.forename: U.
authors.initials: U
authors.lastname: Cinamon
authors.forename: M.
authors.initials: M
authors.lastname: Ron
authors.forename: M.R.
authors.initials: MR
authors.lastname: Wexler
authors.forename: A.
authors.initials: A
authors.lastname: Eldad