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For more than a year now, skin allografts (SA) have been successfully used to treat military and civilians with large burn lesions. This technique is one of the most effective in the treatment of II-III-degree burns.

According to modern protocols, the first step is to remove dead skin from such patients. Subsequently, to speed up the healing process, the affected area is covered with bioimplants from a deceased donor for up to several months. Of course, pigskin is also suitable for this purpose. However, it can effectively perform its function for less than two weeks. After that, it must be removed. During this time, severe burns simply do not have time to heal. Therefore, in cases where the area of injury is large and the patient needs to be stabilized as soon as possible, the use of SA is perhaps the only effective treatment.

At the same time, the implantation of skin allografts does not require the selection of a donor-recipient pair, since after processing and preservation, the biomaterials become low-immunogenic, that is, they do not cause a sharp immune response.

As of the beginning of July 2023, about 10 m² of skin allografts had been produced. Of these, approximately 8.7 m² have already been used to save patients.

Currently, 8 civilian and military medical institutions in Odesa, Kyiv, Lviv, Cherkasy, Vinnytsia and Dnipro use SA for the treatment of burns.

 

From government decree to the start of skin production

The development of the industry was stimulated by russia’s full-scale war against Ukraine. The number of heroes injured by enemy fire at the front and civilians whose lives were destroyed by another rocket attack is growing almost every day. In order to improve the quality of care for victims with severe burns and save as many lives as possible, from the very beginning of russia’s overt aggression. The Ministry of Health of Ukraine has accelerated its work on the development of the production and use of bioimplants.

The legal basis for the rapid development of the industry was a resolution of the Cabinet of Ministers of Ukraine of 5 September 2018. This legal act regulated “Some issues of the pilot project implementation on changing the mechanism of financial support for surgical treatment for transplantation of organs and other anatomical materials”. The amendments made to it in March 2022 and supported by the relevant order of the Ministry of Health allowed the production of skin allografts to begin in May of that year.

The first “skin banks” were launched in the Dnipro branch of the State Enterprise “Bioimplant” of the Ministry of Health of Ukraine and at the Lviv City Emergency Hospital named after St. Panteleimon. Until now, skin bioimplants have not been used in Ukraine. The treatment of burn disease was carried out using artificial coatings or xenografts (materials of animal origin).

 

How does the algorithm for filling skin banks work?

The SA production process can be divided into three conventional stages.

Stage 1: Transplant coordinators at medical institutions, forensic or pathology offices obtain consent from relatives of deceased donors to remove skin fragments.

Stage 2: Under aseptic conditions, which involves a set of measures to prevent infection of biomaterials, and using special equipment, skin fragments of the deceased donor are removed and then packed in sterile, sealed bags. Information about this is mandatorily entered into the Unified State Transplantation Information System (USTS).

Stage 3. Under controlled temperature conditions, the anatomical materials are transported to the production facilities, where they undergo further processing and preservation.

As a result, sterile SA bioimplants are produced, which, if properly stored, remain usable for up to 2 years.

 

What determines the supply of donor skin?

The stocks in skin banks primarily depend on people who are willing to be sacrificial and consent to the removal of biomaterials to save others. Secondly, it depends on the number of licensed institutions that have the right to withdraw anatomical materials. Among them, in particular, are the Poltava and Dnipro Regional Forensic Medical Examination Bureaus and the St. Panteleimon Lviv City Emergency Hospital. Finally, only if the donor is free of blood-borne infections and diseases, the skin is preserved and turned into bioimplants.