Monday, November 12, 2007

Cadaver Skin Fills the Gap in Burn Cases


Title: Cadaver Skin Fills the Gap in Burn Cases
Author: Amanda Schaffer
Source: The New York Times
Publication: May 2, 2006

Although much new and innovative progress is being made toward the creation of artificial skin products for grafting, the treatment for burn patients chugs along, relying on older, more traditional methods. In the May 2006 New York Times article by Amanda Schaffer, “Cadaver Skin Fills the Gap in Burn Cases,” the reality of skin grafting and the most common source of skin for grafting—cadavers—is described and evaluated.

Cadaver skin, the most favorable option for grafting (aside from autologous grafts) over the past 40 years, has thoroughly cemented itself as a significant player in the realm of skin grafting. The skin is harvested from donors very soon after death; however, the process of searching for and locating viable donors can be difficult and unfruitful. Cadavers are only eligible after extensive testing for risk factors that may harm the patient, and even if the skin is deemed perfect for skin grafting, the family of the deceased must consent to the procedure.

The article clearly outlines the process involved in preserving cadaver skin. Any given cadaver can yield approximately four square feet of skin, and once removed, the skin is sliced into strips and stored in freezing temperatures. When needed for a graft, the skin is removed, put through a meshing machine to facilitate stretching of the skin, and subsequently attached to the affected burn area.

Cadaver skin has clear advantages for use in skin grafting. Using human skin instead of the new and exciting artificial skin products in development can lessen the chance for infection and quicken the healing process. Since it is a real human organ, graft patients may not feel as much of a difference between their unharmed and the transplanted skin. Logistically, cadaver skin is beneficial because it can be effectively stored for up to five years.

Although the article was thorough when describing the process of cadaver skin use and introducing several of the new research endeavors to create artificial skins such as Integra and Epicel, the path to becoming a skin donor and the function of skin banks were not heavily discussed. Schaffer briefly mentions that patients undergoing gastric bypass surgery who would like to donate excess skin cannot do so due to the shortcomings of current skin harvesting procedures—but doesn’t follow up to explain the techniques or why they are inadequate.

Becoming a skin donor may seem very straightforward — in many states, preference regarding organ donation can be listed right on the driver’s license. However, as previously mentioned, the family of the deceased must agree to allow skin to be removed after death, and when faced with the decision, many relatives refuse the procedure. “Skin donor program will help treat burn victims,” appearing in the Atlanta Business Chronicle, articulated the reality that many families are uncomfortable with this idea of skin donation— after all, how many people would agree to let their loved ones be ‘skinned’ before the funeral service? The thing that most families do not realize, however, is that grafts are mainly harvested from inconspicuous areas, such as the thighs and buttocks. These grafts can be extremely beneficial for burn victims whose bodies have been destroyed in tragic fire accidents. [@http://www.bizjournals.com/atlanta/stories/2000/10/30/focus6.html].

Should the decision to be a donor be less optional? In the USA, the percentage of listed donors who do not actually end up giving their organs, especially their skin, is rather high. Is there another way to encourage families to agree to the harvesting of their loved ones’ most prominent organ? If a donation is made, it is generally accepted that the costs required to remove the cadaver’s skin is absorbed by the tissue bank— but should an additional payment be made to families who assent? A financial incentive would probably increase the number of donations made, but admittedly, it sounds strange to pay people to give up pieces of their dead family members.

The endeavor to improve the effectiveness of cadaver skin grafting should be addressed with at least as much importance as the ventures to innovate artificial skins and new techniques for grafting procedures. Why? The enhancement of a pre-existing, proven-to-work method seems a wise path to pursue—after all, if cadaver skin grafting became easier and more accessible, maybe the development of synthetic grafts would not be as pressing of a matter. Perhaps the focus and efforts in the field should be centered on the advancement of current procedures rather than the creation of new ones. Unfortunately though, the funding for research and development is most often awarded to the companies pursuing the most exciting and ingenious new products and techniques. This reality may signal a need for reevaluation, in some situations, of the priorities that biotechnology strives to achieve. In this case especially, shifting the focus and resources to more basic forms of education and training may significantly benefit the given medical arena.

-JG

1 comment:

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