SETTING UP A SKIN BANK
Dr. Sunil KeswaniCosmetic ,Burn Surgeon, & Medical Director,National Burns Centre.
ORGAN DONATION
Most popular organ donation in terms of life-saving is blood and hence most meaningful
Eye donation is fast becoming popular, and one is aware of the possibility to donate eyes after death
Kidneys and liver are donated as well but this is less common due to complexities involved
The next achievable organ donation will be human skin. Hence the concept of SKIN BANK
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SKIN BANKING
THE PURPOSE BEHIND…
SKIN BANKING:
Skin banking is a facility where the skin is collected from eligible deceased donor and processed as per international protocols.
Skin can be stored in the skin bank at 4-80 Celsius up to 5 years.
THE RATIONALITY OF THE PROJECT:
In case of extensive burns, the protective barrier- skin is burnt.
Leading to infection, in most cases becomes fatal.
Patients can be saved if we have enough skin in Skin bank.
MAGNITUDE OF THE PROBLEM
The estimated annual burn incidence in India is approximately 6-7 million per year.
Nearly 1 to 1.5 lac people get crippled and require multiple surgeries and prolonged rehabilitation
Seventy percent of the burn victims are in most productive age group of 15 to 40 years .
most of the patients belong to poor socioeconomic strata.
Source: Indian J Plast Surg. 2010 September; 43(Suppl): S6–S10.
NEED OF SKIN BANK
Lesser hospital stay. Cost of treatment goes down. Reduced pain. Increased survival rate. Results in less scarring
WHY DOES ONE NEED DONATED SKIN AFTER MAJOR BURN??
SKIN
The body’s first line of defense
Is water proof and prevents infection from entering the body
When severely damaged, the defense mechanism breaks down
If untreated, bacterial infection, dehydration, loss of protein and electrolytes takes place
Ultimately the victim dies
National Burns Centre
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SKIN
National Burns Centre
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KINDS OF BURNS
Dry Burns – Flame Scald Burns
National Burns Centre
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Thermal Burns
KINDS OF BURNS (CONTD.)
National Burns Centre
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Chemical Burns – Acid, Alkali
Electrical Burns – Electrical Spark and Electrical
Shock
Radiation Burns – Nuclear, Sunburn, X-Rays
THERMAL BURN PARTIAL AND FULL THICKNESS
National Burns Centre smkeswani@gmail
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CADAVERIC SKIN HARVESTING
Most preferred donor skin
Only the superficial layers of the skin are harvested from thighs and back
No disfigurement
No bleeding
No matching is required
Can be harvested in 45 minutes
Should be harvested within 6 hours after death
National Burns Centre
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EXCEPTIONS:
People expired due to:
HIV and HBsAg negative
Skin disease
Cancer
Jaundice
Sexually transmitted disease
Severe infection
National Burns Centre
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PHASES OF SKIN BANKING ESTABLISHMENT
1. SETTING UP THE NECESSARY INFRASTRUCTURES AND EQUIPMENTS.
2. RECRUITING MANPOWER.3. CREATING AWARENESS ABOUT SKIN DONATION.4. RETRIEVAL.5. PROCESSING.6. STORAGE.7. QUALITY MANAGEMENT SYSTEM FOR
CONSISTENT QUALITY. 8. MEDICAL DOCUMENTATION.
Sr. No. Description Approximate cost (INR) Use
1 Furniture &Fixtures 3,00,000 For skin banking facility
2 Bio safety cabinet 3,00,000 For skin processing.
3 Skin Donation Vehicle 5,00,000 For Transportation.
Cold Room 4,50,000 For skin storage5 Sealer 5,000 For Sealing the Bag.
6 Mesher 3,50,000 For Meshing the Skin.
7 Shaking Incubator 1,70,000 For shacking the Skin at particular Temperature.
8 Dermatome 5,50,000 For Harvesting the Skin.
9 Walk in Fridge 5,00,000 For Storing the Skin.
10 Computer & Accessories 75,000 For storing data
11 A/C 75,000 Skin bank processing room and Office
Total Cost 27,75,000
INFRASTRUCTURE COST
INFRASTRUCTURE
Changing Room 50sq.feet
Skin Processing Room 400sq.feet Skin storing Cold Room (Outer View) 100sq.feet
(Administrative office 300sq.feet)
EQUIPMENTS
Shaking incubator
Biosafety cabinet Hot air oven
Sealer
DERMATOME USED FOR SKIN HARVESTING
FULL VIEW OF DERMATOME
PERSONNEL COSTING
Fixed personnel Skin Processing Team2 members- (preferably
biotechnologist/microbiologist) Work- Skin processing Skin donation kit preparation Documentation Quality management . Overall management of skin
bank Salary-Aprox.
(Rs15,000x2)p/m
Floating personnel Skin Donation team-(Existing staff of the hospital)
Team consisting of 4 members1Team leader - Doctor/trained technician.3 Assisting members.- nurses/paramedics.The skin bank has to be in an hospital set -up so as to have enough trained manpower for attending skin donation call 24x7 round the year.The average cost per call cost about Rs.5000(Includes Consumables, transport and incentives to the team )
RETRIEVAL
Clean body with Betadine
Skin Harvesting with the help of Dermatome
Dressing body after harvesting
Skin Ready for harvesting
Skin Processing Trimming the skin sample
SKIN PROCESSING AT SKIN BANK
SKIN PROCESSING-PHASE III
LABELLING AND PRESERVATION
MEDICAL DOCUMENTATION
Donor registration verification. Serological investigation verification after death. Documentation of different phase of skin processing in
skin bank . Documentation of recipient name and hospital and
Doctor concerned. Record of rejected skin during the processing if the any
serological finding ,microbiological test report are awaited .
National Burns Centre smkeswani@gmail
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OUR EXPERIENCE WITH SKIN DONATION OVER LAST FOUR YEARS IN MUMBAI
Year Number of Donation
Number of Awareness Program Conducted
2010 15 35
2011 54 60
2012-
2013
88
191
126
156
YEAR 2010 YEAR2011 YEAR 2012 YEAR 20130
50
100
150
200
250
YEAR WISE STATISTICS OF SKIN DONATIONS
Jan
Feb
Mar
April
May
June Ju
ly
Augu
stSe
pt OctNov Dec
0
5
10
15
20
25
30
YEAR 2010YEAR 2011YEAR 2012YEAR 2013
COMPARATIVE DATA OF NO. SKIN DONATIONS IN LAST 4 YEARS
•Awareness by using newspapers, Magazines and journals
•Conducting lectures in school, colleges and institutes.
•Community Awareness Programme for Skin Donation.
•With the help of NGO’s.
•By organizing Seminars on Skin Donation.
•Awareness by promoting the burns victims to share their trauma in front of the public (Burn survivor community).
AWARENESS
social worker conducting school education programme
Students attending seminar on Skin donation
STANDEES TO BE PUT ON DISPLAY IN HOSPITALS AND MALLS
AWARENESS MATERIALS
PLEDGE FORM TO BE KEPT AT PUBLIC PLACES
Outer View Inner View
Kangaroo Pouch
Pledge Form to be filled and returned to National burns Centre
Magnetic Sticker to be displayed on Fridge as reminder
Cards for the kangaroo pouch for the Pledge Form
Pocket Card for the skin donor
… spread awareness
Write ups / Articles in Magazines, Bulletins, Newspapers, Journals, and Social Media
… spread awareness
Hoardings including public transport like BEST Buses, Auto rickshaws, trains, etc…
… spread awareness• Conduct lectures in schools, colleges,
institutes• Seminars for general practitioners, general
public
… spread awareness
Call the HOD & TC. of the Hospital you are affiliated with to the seminar
… spread awarenessInclude Skin Donation Awareness during other community programs in urban and rural areas
… spread awarenessArt or talent competition with theme as Skin, Eye, Organ Donation
NAME OF STUDENT- HARESH JAIPRAKASH DHANU NAME OF COLLEGE- L S RAHEJA SCHOOL OF ARTS
1ST PRIZE WINNER
NAME OF STUDENT- CHINAMYEE MUKADAM NAME OF COLLEGE- RACHANA SANSAD COLLEGE OF APPLIED ART AND CRAFT
2ND PRIZE WINNER
NAME OF STUDENT- BHAVEN D FURIA NAME OF COLLEGE- L S RAHEJA SCHOOL OF ARTS
Joint 3rd PRIZE WINNER
CONCLUSION
Half of the burn patients who are dying now can be saved if more skin banks are established in the country to collect more skin for covering extensive burn wound after early excision.
Early removal of dead skin and homografting will lead to quicker healing with less scar.
Thank You