Cadaveric allograft as adjunct therapy for nonhealing ulcers

The objective of this study was to describe the results of a retrospective survey of 27 patients who were treated with cadaveric skin allograft as an adjunct therapy for wound management. The evolution, benefits, indications, and future of cadaveric skin allografts are also discussed. Glycerin-preserved, frozen, cadaveric split-thickness skin allograft was sutured to excised wounds and held in place with a stent dressing. Retrospective data recovered from wound assessment forms and progress reports were used to evaluate the effectiveness of this treatment. The etiology, pre- and postexcisional volume, depth of debridement, time taken for granulation tissue to first appear, allograft life span, volume post allograft removal, healing time, time expired from allograft to skin grafting, and reported pain were documented and presented. A total of 34 ulcers in 27 patients of various etiologies were evaluated. Pre-excisional volume averaged 6448.2 mm3, while the volume post allograft debridement averaged 9159.0 mm3. The length of time the biologic dressing remained in place averaged 29.1 days. Granulation tissue became first apparent through the fenestrations in the graft at an average of 13.4 days. Pain was notably reduced in 53% of the patient's post debridement with application of allograft. Only 12% of the patients experienced an increase in pain and 35% related no change. Most (65%) of the patients healed via secondary intention. The rest (35%) underwent split-thickness skin grafting. The average healing time was 113.9 days. No infections occurred while the allograft was in place. Lower extremity wounds present many challenges that may lengthen the course of treatment. As healing time increases, so too does the risk of various complications such as infection, desiccation, and damage to underlying soft tissues. The benefits of allograft treatment are particularly noteworthy in areas where bone and/or tendon are exposed. In these cases it becomes especially difficult to promote granulation tissue growth. Cadaveric skin allografts aid in preventing desiccation, help to control infection, and can substantially reduce patient discomfort.