Usage of autograft and allograft skin in treatment of burns in children

Large burns still present problems regarding the availability of enough autologous skin cover. The two Units have no experience in using cultured keratinocytes as a substitute for split skin grafts, as these are not available in the Kingdom of Saudi Arabia and are therefore not practical. At the same time, we have been obliged to abandon the use of human allograft skin from cadavers and other patients, because it is not acceptable in our culture. Our favoured method for resurfacing large burn areas in children is to use widely meshed autologous skin, overlaid with meshed allograft from a parent (to minimise the risk of HIV transmission). We report our experience using this technique in five children. The fate of the intermingled grafts has been followed clinically, and in some cases histologically. There has been long-term persistence of the parental skin without rejection and although allograft dermis appears to contribute to the final cover, the cellular elements of the parental skin apparently do not survive.