Skin graft (top), and the healed region

Skin grafting is an essential part of the post-operative treatment for severe cases of burns. However, acquiring the skin for the purpose is both difficult and expensive.

So far the most common way of doing this was to take it from the patient himself. “But when the patient has suffered 60-70 per cent burns, it becomes impossible to use his or her skin. In such cases we need donors,” explains Dr Anupam Golus, plastic surgeon, Westbank Hospital, Howrah.

Skin banking is a process in which skin is removed from a person’s body, tested for suitability, packaged, stored and finally reused to heal burn wounds as an autograft (from the same individual) or allograft (from a donor). Autograft is a permanent process and is generally used to treat second (affecting both the outer and underlying layer of the skin) and third degree (extending into deeper tissues) burns as well as for reconstructive surgery. Allograft on the other hand is used as a temporary burn wound graft, which is automatically rejected by the recipient within 7-21 days. Until that happens, however, it closes a wound, provides a barrier against infection and fluid loss, decreases pain and heals the underlying tissues.

“Unfortunately, there are no skin banks in India,” says Dr Sachin Varma, consultant dermatologist, Apollo Gleneagles, Calcutta. This is because most skin grafts for permanent reconstructive surgery require high immuno-suppressants (medicines to suppress the patient’s immune system as the chances of rejection are high). And as many patients are not particular about follow ups, most hospitals do not want to risk it. But skin grafts for burn patients entail no such complications, says Dr Varma.

The people of eastern India, however, can now look forward to a skin bank in Calcutta. Westbank is set to extend its burns unit and establish one by the end of 2008.

Skin harvested from donors may be used fresh or frozen. Fresh skin grafts are maintained in a fluid medium to keep the cells alive and nourished for approximately 14 days. Often the harvested tissues decay owing to bacterial degradation and hence most banks freeze the grafts for a longer shelf life. This involves soaking the tissue in a special medium (cryoprotectants) to minimise injury and then freezing it. Most tissues are frozen at 1-5° C per minute and then stored at ultra-low temperatures (below -60° C).

However, how successful the skin bank will be remains a question, considering that few individuals in West Bengal donate organs; the state thus has no proper organ bank. “But we must make a beginning. We must try to educate the people and create mass awareness. We can also take skin from the dead,” says an optimistic Dr Golus.