title: Inability to determine tissue health is main indication of allograft use in intermediate extent burns.
abstract: BACKGROUND
  Cutaneous allograft is commonly used in the early coverage of excised burns when autograft is unavailable. However, allograft is also applied in intermediate-extent burns (25-50%), during cases in which it is possible to autograft. In this population, there is a paucity of data on the indications for allograft use. This study explores the indications for allograft usage in moderate size burns.
  
  
  METHODS
  Under an IRB-approved protocol, patients admitted to our burn unit between March 2003 and December 2010 were identified through a review of the burn registry. Data on allograft use, total burn surface area, operation performed, operative intent, number of operations, intensive care unit length of stay, and overall length of stay were collected and analyzed. Data are presented as means±standard deviations, except where noted.
  
  
  RESULTS
  In the study period, 146 patients received allograft during their acute hospitalization. Twenty-five percent of allograft recipients sustained intermediate-extent burns. Patients with intermediate-extent burns received allograft later in their hospitalization than those with large-extent (50-75% TBSA) burns (6.8 days vs. 3.4 days, p=0.01). Allografted patients with intermediate-extent burns underwent more operations (10.8 vs. 6.1, p=0.002) and had longer hospitalizations (78.3 days vs. 40.9 days, p<0.001) than non-allografted patients, when controlled for TBSA. Clinical rationale for placement of allograft in this population included autograft failure, uncertain depth of excision, lack of autograft donor site, and wound complexity. When uncertain depth of excision was the indication, allograft was universally applied onto the face. In half of allografted intermediate-extent burn patients the inability to identify a viable recipient bed was the ultimate reason for allograft use.
  
  
  CONCLUSIONS
  Unlike large body surface area burns, allograft skin use in intermediate-extent injury occurs later in the hospitalization and is driven by the inability to determine wound bed suitability for autograft application. Allograft application can be utilized to test recipient site viability in cases of autograft failure or uncertain depth of excision.
authors.affiliation: Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States; Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States; Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States.
authors.forename: John L
authors.initials: JL
authors.lastname: Fletcher
authors.affiliation: Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States.
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
authors.affiliation: Division of Plastic Surgery, Brigham and Women's Hospital, Boston, MA 02115, United States.
authors.forename: Indranil
authors.initials: I
authors.lastname: Sinha
authors.affiliation: Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States.
authors.forename: Kai P
authors.initials: KP
authors.lastname: Leung
authors.affiliation: Brooke Army Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234, United States.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Renz
authors.affiliation: Clinical Division and Burn Center, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States; Dental and Trauma Research Detachment, U.S. Army Institute of Surgical Research, 3650 Chambers Pass, Fort Sam Houston, TX 78234-6315, United States. Electronic address: rodney.k.chan@us.army.mil.
authors.forename: Rodney K
authors.initials: RK
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D001830:Body Surface Area; D002053:Burn Units; D002056:Burns / Q000601:surgery*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008889:Military Personnel; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D014182:Transplantation, Autologous / Q000379:methods*; D014184:Transplantation, Homologous / Q000379:methods*; D015599:Trauma Severity Indices; D017211:Treatment Failure; D055815:Young Adult
keywords: Autograft failure; Cryopreserved allograft skin; Depth of excision; Tissue health