title: Clinical application and viability of cryopreserved cadaveric skin allografts in severe burn: a retrospective analysis.
abstract: BACKGROUND
  Cadaveric cutaneous allografts are used in burns surgery both as a temporary bio-dressing and occasionally as definitive management of partial thickness burns. Nonetheless, limitations in the understanding of the biology of these grafts have meant that their role in burns surgery continues to be controversial.
  
  
  METHODS
  A review of all patients suffering 20% or greater total body surface area (TBSA) burns over an eight year period that received cadaveric allografts were identified. To investigate whether tissue viability plays a role in engraftment success, five samples of cryopreserved cadaveric cutaneous allograft processed at the Donor Tissue Bank of Victoria (DTBV) were submitted to our laboratory for viability analysis using two methods of Trypan Blue Exclusion and tetrazolium salt (MTT) assays.
  
  
  RESULTS
  During the study period, 36 patients received cadaveric allograft at our institution. The average total burn surface area (TBSA) for this group of patients was 40% and all patients received cadaveric skin as a temporizing measure prior to definitive grafting. Cadaveric allograft was used in complicated cases such as wound contamination, where synthetic dressings had failed. Viability tests showed fewer than 30% viability in processed allografts when compared to fresh skin following the thawing process. However, the skin structure in the frozen allografts was histologically well preserved.
  
  
  CONCLUSIONS
  Cryopreserved cutaneous cadaveric allograft has a positive and definite role as an adjunct to conventional dressing and grafting where available, particularly in patients with large TBSA burns. The low viability of cryopreserved specimens processed at DTBV suggests that cell viability in cadaveric allograft may not be essential for its clinical function as a wound dressing or even as permanent dermal substitute.
authors.affiliation: Skin Culture Laboratory, Victorian Adult Burns Service and Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: H.Cleland@alfred.org.au.
authors.forename: Heather
authors.initials: H
authors.lastname: Cleland
authors.affiliation: Victorian Adult Burns Service and School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: J.Wasiak@alfred.org.au.
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
authors.affiliation: Skin Culture laboratory, Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: hannah.dobson@gmail.com.
authors.forename: Hannah
authors.initials: H
authors.lastname: Dobson
authors.affiliation: Skin Culture laboratory, Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: M.Paul@alfred.org.au.
authors.forename: Michelle
authors.initials: M
authors.lastname: Paul
authors.affiliation: Skin Culture laboratory, Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: G.Pratt@alfred.org.au.
authors.forename: George
authors.initials: G
authors.lastname: Pratt
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: eldho.paul@monash.edu.
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.affiliation: Donor Tissue Bank of Victoria, 57-83 Kavanagh Street, Southbank, Melbourne, Australia. Electronic address: marisah@vifm.org.
authors.forename: Marisa
authors.initials: M
authors.lastname: Herson
authors.affiliation: Skin Culture Laboratory, Victorian Adult Burns Service and Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia. Electronic address: shiva.akbarzadeh@monash.edu.
authors.forename: Shiva
authors.initials: S
authors.lastname: Akbarzadeh
mesh_terms: D000328:Adult; D064591:Allografts / Q000473:pathology*; D002056:Burns / Q000601:surgery*; D002102:Cadaver; D015331:Cohort Studies; D015925:Cryopreservation / Q000379:methods*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012867:Skin / Q000473:pathology*; D016038:Skin Transplantation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Allograft; Burns; Cadaver; Skin; Viability