Can removal of epidermis delay rejection of cadaveric dermis-only allograft? A proof of concept study

Background: Skin allograft, used as a biological dressing, is usually rejected after 2 weeks. Epidermis contains immunogenic cells and its removal reduces antigenicity of allograft and delays its rejection. Materials and Methods: This proof of concept observational study was conducted in 50 patients of deep burns and posttraumatic wounds to evaluate the biological response of cadaveric glycerol-preserved dermis-only allograft. The epidermis was removed surgically, and the endpoints of healing or graft rejection were compared with historical controls of full-thickness allografts. Results: Dermis-only allograft take was seen in 82% patients at 20 days; in 34% patients at 4 weeks and in 16% patients at 8 weeks. Conclusion: Surgical removal of epidermis from cadaver allograft reduces its antigenicity and enables its longer survival.