Skin donation: How does it work?

What is the relationship of plasma in blood and skin donation?

Whenever anyone gets burns on the body because of some accident or intentional criminal act, the pain out of those burns is simply unbearable. This pain is more horrible than any other possible pain known to anyone in their life-time.No one can imagine it.If you try to cover the burnt portion of the body by cloth then the pain increases to such a level that the patient has to be given morphine to calm him down. Morphine is given because this pain may last till death and medicines / ointments are applied by using bandage with meshed cotton gauze, only after patient is forced to be calm.

If you want to know what may be a situation of hell, please visit any burnt cases ward in any hospital, big or small.You will not be able to bear the sighs and fearsome painful screams of the burnt patients.Even a small flow of air on the burnt portion of burn generates unbearable pain. Neaurogenic shock, weakness and horrible pain may lead to sudden death.

Just like a burnt brinjal, the yellowish liquid called plasma starts flowing out of burnt skin. Flow does not stop easily and immediate action is not taken, blood start becoming thick due to loss of plasma and a condition called "haemoconcentration" may lead to death of the patient.There is approx. 5 litres of blood in a normal human body.As plasma flows out and proportion of other components of blood start increasing in blood, it leads to "haemoconcentration" which is very dangerous for the patient because this condition of blood leads to thick blood which when flows into kidney, it leads to reduced supply of blood in whole body and kidney fails after some time and patient may die.If this thick blood clots reach blood before failure of kidney, patient may die much earlier before the kidney fails.

Reducing the flow of plasma from skin is highest priority for any burnt patient.

The skin donated by skin donors is applied on the severely burnt area of the body to stop the flow of plasma.This not just reduces dlow of plasma out of body but decreases the severe pain of the patient to a great extent.This becomes a plaster on the skin and can easily be accepted by the body as natural protection just like patient's own skin.Once this happens, chances of survival of burnt patient increases to a great extent.

Approx.after 3 or 4 weeks of skin transplantation, body starts rebuilding its own skin and the transplanted skin slowly wears off. The pieces of this skin falls off during cleaning and bandaging of the patient's burnt skin and slowly original new skins appears on body

Who can donate skin after death?

1) Any healthy person over the age of 18 can donate skin after death

2) Skin must be removed from dead body within 6 hours after the death.

3) Skin donor should not be infected with serious diseases and

death should not be caused because of such serious diseases.

4) The family of the dead person MUST permit in writing to allow skin donation.

5) Skin is removed from flat portions of the body like back, thighs etc

6) Only the upper very thin layer of the body our of many layers is removed by sterile machine which does not involve any bleeding or disfiguring of the body

7) Any religious ritual can be performed after removal of the skin

8) Skin after removal is preserved in 50% glycerol solution before it is processed further.

9) This skin is preserved at 4 degrees temp. after full checking for bacterial/ fungal tests.

10) Skin donation is extremely essential for any major accidents of fire or natural calamities

Ganesh Govund Anande

Ayush blood helpline team head

Contact: 8208386690 / 9225663999

Please call only between 5 m and 6 pm.

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Courtesy website of Region's hospital in USA

https://www.healthpartners.com/hospitals/regions/specialties/burn-center/skin-grafting/

A first degree or superficial burn heals naturally because your body is able to replace damaged skin cells. Deep second and full-thickness burns require skin graft surgery for quick healing and minimal scarring. In the case of large burn size, patients will need more than one operation during a hospital stay.

Skin grafting is done in a surgical procedure that consists of:

• The removal of injured tissue

• Selection of a donor site, an area from which healthy skin is removed and used as cover for the cleaned burned area

• Harvesting, where the graft is removed from the donor site

• Placing and securing the skin graft over the surgically-cleaned wound so it can heal

To help the graft heal and become secure, the area of the graft is not moved for five days following each surgery. During this immobilization period, blood vessels begin to grow from the tissue below into the donor skin, bonding the two layers together. Five days after grafting, exercise therapy programs, tub baths and other normal daily activities resume.

There are a variety of skin grafts, some that provide temporary cover and others that are for permanent wound coverage.

Temporary burn wound covering

Allograft, cadaver skin or homograft is human cadaver skin donated for medical use. Cadaver skin is used as a temporary covering for excised (cleaned) wound surfaces before autograft (permanent) placement. Cadaver skin is put over the excised wound and stapled in place. After surgery, the cadaver skin may be covered with a dressing. This temporary covering is removed before permanent autografting.

Xenograft or heterograft is skin taken from a variety of animals, usually a pig. Heterograft skin became popular because of the limited availability and high expense of human skin tissue. Wound coverage using heterograft is a temporary covering used until autograft.

Permanent burn wound covering

Autograft is skin taken from the person burned, which is used to cover wounds permanently. Because the skin is a major organ in the body, an autograft is essentially an organ transplant. Autograft is surgically removed using a dermatome (a tool with a sharp razor blade). Only the top layer of skin is used for donor skin. The site the skin is taken from will heal on its own. There are two types of autografts used for permanent wound coverage:

Sheet graft is piece of donor skin harvested from an unburned area of the body. The size of the donor skin is about the same size as the burn wounds. The donor sheet is laid over the cleaned wound and stapled in place. The donor skin used in sheet grafts does not stretch; it takes a slightly larger size of donor skin to cover the same burn area because there is slight shrinkage after harvesting. When the body surface area of the burn is large, sheet grafts are saved for the face, neck and hands, making the most visible parts of the body appear less scarred. When a burn is small and there is plenty of donor skin available, a sheet graft can be used to cover the entire burned area.

The disadvantages of sheet grafts are that small areas of graft might be lost from build-up of fluid (hemotoma) under the sheet right after surgery and also need a larger donor site than does meshed skin. A sheet graft is usually more durable and scars less.

Meshed skin grafts very large areas of open wounds are difficult to cover because there might not be enough unburned donor skin available. It is necessary to enlarge donor skin to cover a larger body surface area. Meshing involves running the donor skin through a machine that makes small slits that allow expansion similar to fish netting. In a meshed skin graft, the skin from the donor site is stretched to allow it to cover an area larger than itself. Healing occurs as the spaces between the mesh fill in with new skin growth. The disadvantages of meshing are that it is less than a sheet graft and that the larger the mesh, the greater the permanent scarring.

Meshing allows blood and body fluids to drain from under the skin grafts, preventing graft loss, and it allows the donor skin to cover a greater burned area because it is expanded.

How skin grafts are held in place

Surgical staples are used to secure the edges of a graft to healthy skin. The staples are put in and taken out with a tool that looks like a pliers. Once the edges have healed together and the graft is stable, the doctor removes the staples.

Sometimes the doctor sutures (stitches) a graft in place with a needle and silk or nylon thread. When the graft is stable, the stitches are removed.

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त्वचा दान और प्लास्मा का क्या संबंध है ?

जब कोईभी व्यक्ती जब आग में जल जाता है और जली हुई सारी त्वचा का जो मरणप्राय दाह और भयंकर असहनीय वेदना होती है उसका अंदाजा कोई नही कर सकता है.कपडेसे आप उसे ढकनेकी भी कोशिश करो तो पीडा और ज्यादा हो जाती है.असह्य पीडा कम हो इसके लिये मॉर्फीन दिया जाता है.

यह वेदना मरण समयतक कमी नही हो सकती है.ड्रेसिंग करने लिये भी भूल देकर मरहम के साथ कपडेका जालीदार बँडेज लगाया जाता है.

वेदनाओकी कोई सीमा नही होती है.बर्न वॉर्ड में जाओगे तो चिल्लाने और कराहनेकी आवाज सून नही पाओगे ऐसी भयंकर स्थिती होती है .हवाका झोका भी ऊस आदमीकी जली हुई त्वचा में भयानक पीडा उत्पन्न करता है

न्यूरोजेनिक शॉक,चोट लगने की थकान,और गंभीर दर्द के कारण रोगी की मृत्यु हो सकती है.

भुने बैंगन के रस के समान त्वचा की छाल से निकलने वाला प्लाज्मा रोगी के शरीर से बाहर निकल जाता है।और अंदाजन 5 लीटर रक्त कि मात्रा जो शरीर में है , कम होती जाती है और haemoconcentration से वह व्यक्ती मर सकता है. haemoconcentration तब होता है जब रक्तमे प्लाज्मा कम होकर बाकी पेशिया ज्यादा हो जाती है और रक्त का घनापन बढ जाता है,किडनी में यह घना रक्त जाने से किडनी का रक्त का सप्लाय कम हो कर धीरे धीरे बंद जो जाता है और किडनी फेल हो जाती है और इस वजहसे शॉक से आदमी मर जाता है.

यदी उसके पहले यही खूनकि गुठलीया मस्तिष्क मी जाये तो भी जान जा सकती है.इस स्थिती को यदी रोकना है तो प्लाज्मा का शरीरकें बाहर बहकर जाना तुरंत रोक देना जरुरी हो जाता है.

त्वचा दान से मिली हुई त्वचाको आग से झुलस गयी त्वचापर आवरण कि तरह लगाया जाता है जिसे भयानक वेदना कम हो सकती है.और यदि त्वचा रोगी के शरीर द्वारा स्वीकार की जाती है, तो यह एक प्रकार का प्लास्टर बन जाता है और इसे त्वचा के रूप में स्वीकार किया जाता है।

शरीरसे बाहर जानेवाला प्लास्मा का बहाव रूक जाता है और वेदना भी कमी हो जाती है.ऐसी स्थितीमें इन्सान बचने की संभावना बढ जाती है

त्वचादान कौन और कैसे कर सकता है?

१) १८ साल से ज्यादा कोईभी व्यक्ती मृत्यू त्वचा दान कर सकता है

२) मृत्यू के बाद ६घंटोके अंदरही त्वचा निकालना जरुरी है

३)त्वचादान करनेवाले व्यक्तिको त्वचाका कोईभी रोग न हो

४)मृत्यू कोईभी गंभीर बिमारीसे न आया हो

५)मृत व्यक्तिके परिवारकी अनुमती होना जरुरी है

६)त्वचा मृतक के शरीरकि पीठं,पिंडरीया और जांघा से निकाली जाती है

७)त्वचा मशीन से निर्जंतुक रीतिसे निकाली जाती है और त्वचा विद्रुप नही होती है

८)खून नही निकलता है और अत्यंत पतला स्तर निकाल लेते है

९)उसके बाद कोईभी धार्मिक विधी आसानी से किया जा सकता है

१०) निकाली गयी त्वचा 50% ग्लीसरॉल की डिब्बीमे रखते है

११) ४डिग्री तापमान पर सुरक्षित रखी जाती है

१२) ऐसी त्वचाकी बॅक्टेरियल और फंगल टेस्ट की जाती है और दोनो

निगेटिव्ह आने बाद ही किसी रुग्णपर लगायी जाती है

१३)भयानक आग या युद्ध जन्य परिस्थितिमे बहुतही उपयोगी है

श्री गणेश गोविंद आनंदे

आयुष ब्लड हेल्पलाईन टीम प्रमुख

8208386690 / 9225663999

फोन सिर्फ शाम ५ और ६ के बीच करिये

अनुवाद - अजित वहाडणे / मुंबई

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