Autograft skin

The earliest recorded attempts at organ transplant date back thousands of years.1 More than a few apocryphal descriptions exist from ancient Egypt, China, India, and Rome documenting experimentation with transplantation. For example, an Indian text from the second century bc describes a procedure for nasal reconstruction surgery with the use of autografted skin. Also, Roman Catholic lore has saints Damian and Cosmas replacing the gangrenous leg of a man with the leg of a recently deceased man in the third century ad.1... 

Protein-deficient mice, although responding normally to phytohemagglutinin, were still able to reject skin autografts more rapidly than normally nourished controls which showed striking depression of antibody synthesis to sheep red blood cells (J7). Similarly malnourished rats which had marked suppression of plaque-forming cells and rosetteforming cells showed no difference in skin transplant rejection from their well fed controls (M18). 

Boyce ST, Kagan RJ, Greenhalgh DG, Warner P, Yakuboff KP, Palmieri T, Warden GD (2006) Cultured skin substitutes reduce requirements for harvesting of skin autograft for closure of excised, full-thickness bums. J Trauma 60(4) 821-829... 

Of all forms of skin grafting, autografting is by far the most likely to be successful. In other forms of grafting, a patient is likely to suffer not only from infections developing from the loss of skin, hut also from immune responses as his or her body begins to reject the "foreign" implant, the skin from some nonself source. 

Medawar, P. B. The behaviour and fate of skin autografts and skin homografts in rabbits. J. Anat. 78, 176-199 (1944). 

Experiments with animals have shown that closure of 3 X 1.5-cm, fullthickness skin wounds with Stage 1 membranes provides prompt, reliable protection against infection and fluid loss by a single application. Subsequent removal is not necessary. These findings are the first successful effort to promptly close large, full-thickness wounds, not requiring replacement or the use of an autograft. 

Fig. 16 H E staining of (a) normal skin tissue and (b-d) sections of wounds after treatment with BDEs loaded with TMC/pDNA-VEGF for 10 days, followed by transplantation of ultrathin autografts for 21 days (b), 70 days (c) and 112 days (d). Scale bar 200 pm [187]...

Freeman, A.E., Igcl, H.J., Waldinan, N.I,. and Losikoff, A.M. (1974) A new method for covering large surface area wounds with autografts. I. In vitix> multiplication of rabbit-skin epithelial cells, Arch. Stag., 108, 721-723. 

Historically, using cultured or sprayed-on epithelial autograft to create stable robust epithelium on large wounds has been expensive and unpredictable in its outcome. The lack of dermal support results in friable, unstable cover that shears readily and allows wound contraction. By culturing autologous skin in vitro, the CCS can reduce the morbidity of extensive skin graft harvest and create a stable wound reconstruction with minimal contraction in extensive wounds. The work described above demonstrates proof of concept that CCS can be cultured in vitro and can be applied to integrated, delaminated BTM, and can take and/or deliver cells to the wound to result... 

Loss M., Wedler V, Krinzi W., Meuli-Simmen C., and Meyer V.E. 2000. Artificial skin, split-thickness autograft and cultured autologous keratinocytes combined to treat a severe bum injury of 93% of TBSA. Burns 26 644-652. 

A major problem encountered with Epicel has been epidermal blistering. Small blisters may resolve spontaneously, but larger blisters result in graft failure [34]. This phenomenon has been attributed to absence of dermal-epidermal junction components at grafting. Despite this limitation, the availabihty of Epicel has provided a much needed treatment option for patients with massive burns where donor skin for autograft is extremely limited [34]. 

FIGURE 47.1 Histological comparison of native skin and cultured skin substitute prepared for treatment of pediatric bum patient, (a) Native human skin, (b) Cultured skin substitute in vitro, shown after 6 days of incubation. Graft was transplanted to patient after 10 days of in vitro incubation. (c),(d) Healed autograft (c), and healed cultured skin substitute (d), biopsied 3 weeks after grafting to excised full-thickness burn wounds. Scale bars = 0.1 mm. 

---