Major burns represent one of the most severe forms of trauma, compromising the body’s largest organ and its primary defense system. The skin functions as a critical barrier, regulating internal temperature, preventing excessive fluid loss, and protecting against microbial invasion. When a burn injury is deep and covers a large percentage of the body’s surface area, these functions are lost, leading to immediate risks of severe dehydration and systemic infection. Life-saving treatment for extensive burns requires immediate removal of the damaged tissue and replacement with external coverage to restore this protective barrier.
The Source of Donated Skin for Burn Treatment
The question of whether an individual can donate skin to a burn victim is often misunderstood, as the needs for widespread burn coverage are almost exclusively met by deceased donors. The skin tissue used for this purpose, known as an allograft, is procured by tissue banks from individuals who have consented to tissue donation after death. The skin is harvested in thin, split-thickness layers, primarily from the back and lower extremities.
Standard living skin donation for an unrelated recipient is not a viable treatment option because the recipient’s immune system recognizes the donated tissue as foreign and initiates a rejection process. For this reason, the vast majority of human donor skin is sourced from deceased individuals and is used as a temporary biological dressing. Only skin grafts taken from the patient’s own body, called autografts, can be accepted permanently.
Classification and Function of Graft Materials
Burn treatment relies on a spectrum of materials, each serving a distinct function. The immediate goal is to stabilize the patient by covering the wound bed, where allografts from deceased donors play a significant role. Allografts act as a temporary biological dressing, providing a physical barrier that prevents massive fluid and protein loss and significantly reduces the risk of infection. This temporary cover helps prepare the underlying wound bed for the ultimate, permanent solution.
The body’s rejection of the allograft, typically occurring within two to three weeks, is factored into the treatment plan. The goal is to bridge the time until the patient is stable enough for permanent grafting. The only material that offers permanent wound closure is an autograft, which involves harvesting a thin sheet of the patient’s own healthy skin from an unburned site. Surgeons use a specialized instrument called a dermatome to remove a split-thickness layer, which includes the epidermis and a portion of the dermis.
To maximize coverage from limited healthy skin, the harvested autograft is often put through a meshing device. This device creates tiny, evenly spaced slits, allowing the small sheet of skin to be expanded to cover a much larger area. This meshed skin allows fluids to drain and facilitates healing across the interstices of the graft, where new skin cells eventually grow to fill the gaps.
When a patient has extensive burns, alternative materials are introduced to conserve limited autograft sites. These include temporary dressings and bioengineered substitutes.
Alternative Graft Materials
Temporary dressings include xenografts, which are derived from animal sources, most commonly pigs. Bioengineered skin substitutes may be synthetic matrices or acellular dermal components designed to provide a scaffold for the patient’s own cells to grow into, further supporting the eventual placement of a permanent autograft.
Processing and Storage of Donor Tissue
Once skin tissue is retrieved from a deceased donor, it is transported to a specialized facility known as a tissue bank for processing. The initial step is rigorous screening, which includes reviewing the donor’s medical history and extensive testing for infectious diseases, such as HIV and Hepatitis, to ensure the tissue is safe for transplantation. The skin is harvested in a sterile environment and treated with antibiotic solutions to reduce the presence of bacteria.
Maintaining the tissue’s viability and sterility requires specialized storage methods. The two primary methods are cryopreservation and preservation in a glycerol solution. Cryopreservation involves freezing the tissue at ultra-low temperatures, often using liquid nitrogen, and is preferred for long-term storage as it retains a higher level of cell viability. Glycerolization uses a highly concentrated glycerol solution to dehydrate and sterilize the skin, but results in a non-viable graft.
Before the tissue is released to a burn center, quality control measures ensure it meets strict safety standards and is free of detectable pathogens. This infrastructure makes deceased donor skin a reliable and immediately available resource for burn surgeons.