Search

Recognition of the utility of skin allografts in the treatment of critical burn injuries goes back six decades. Since World War II, the use of allografts in burn treatment has been accepted practice. The material has proved to be highly adaptable as burn care has evolved through the years. However, a number of difficulties have emerged which limit utilisation of these grafts, including the possibility of disease transmission, absence of permanent take and shortage of supply [1]. Nevertheless, as has been clearly shown in two French surveys [2,3], the use of allografts remains unchallenged, despite improvements in local and general burn care. With the aims of improving availability and of reducing delays and administrative charges, a skin bank was planned and installed in Tours in 1986. Allograft procurement, as a component of multi-organ donations, was assigned to the burn surgeon on call; responsibility for skin preparation and preservation was assumed by the Tissue Bank Department of the Blood Centre. This arrangement proved to be effective and remains the same today. During the first 4 years of operation, supplies of allograft were generally adequate. Agreements were made with the other skin banks in France, especially Paris, to transfer supplies when appropriate to alleviate shortages and to distribute surfeits (Fig. 1). Recently, the number of procurements has declined markedly; in fact no allograft skin has been acquired locally for the last 3 years. It must be stressed that this development is not linked to disinterest, increased load of work of the teams involved, nor failure of the organisation. There has been a general decline in donors in France, which is especially obvious in Tours. Confronted by this situation, the Burn Centre in association with the Tissue Bank in Tours decided in 1998 to obtain glycerolised skin allografts from the Euro Skin Bank (GPA) in The Netherlands. This was considered appropriate in view

After third degree burn injuries, grafting remains the only way of healing. Delayed covering increases morbidity and mortality, whereas a high percentage of graft take guarantees wound closure and allows better long-term results.

Comments are presented on a case history of extensive burns associated with 1,1-dimethylhydrazine (UDMH) toxicity in a 31-year-old man. Neurological symptoms dominated early developments. Specific treatment with pyridoxine, while begun late, effected a quite rapid resolution and the subsequent progression of treatment was straightforward. In reviewing previous reported findings, the authors have clarified the distinctive characteristics of UDMH toxicity, the methods for its detection and modes of treatment. They draw conclusions, based on problems encountered, linked to the exceptional character of acute UDMH toxicity especially in its association with extensive burns.

Complement system has been investigated in the first 15 days postburn. Complement titer (measured by a kinetic method of immune hemolysis) decreases immediately after thermal injury. This depression is mainly explained by mechanical leakage and is related to burn surface. No anticomplementary effect has ever been found in this period. After 48 hours complement titer rises. Magnitude and rate of rise are inversely related to the severity of burn trauma (depth and surface). Infection occurrence is statistically related to but somewhat independent of complement levels and interferes with the rate of increase of complement levels. The basis of the rise to normal or elevated complement levels remains unexplained.