• Early debridement and coverage of burn wounds saves lives.
• Allograft is the ‘gold-standard’ for temporary coverage of acute burns

Coomarasamy, C

Hurst, H

Savage, J

Vandal, A

Wong She, R

Open Research

Predicting Allograft Requirement in the Management of Patients With Major Burn Injuries

AUT Scholarly Commons

Predicting Allograft Requirement in the 
Management of Patients with Major Burn Injuries
Jessica Savage1, Hannah Hurst1, Alain Vandal2, Christin Coomarasamy2, Richard Wong She1
1. National Burn Centre, Middlemore Hospital, Counties Manukau District Health Board
2. Centre for Research, Knowledge & Information Management, Counties Manukau District Health Board
R ltI t d ti esu sn ro uc on
• Early debridement and coverage of 
burn wounds saves lives.
• Allograft is the ‘gold-standard’ for 
temporary coverage of acute burns.
The benefits of allograft include:
• Physiological closure of the debrided 
burn wound  
40000
60000
80000
100000
120000
140000
160000
180000
200000
of
 A
llo
gr
af
t R
eq
ui
re
d 
(c
m
2)
Predicting Total Allograft 
requirement 
(Probability that predicted order will 
be sufficiently large)
95%
90%
80%
70%
1
2
4
8
16
32
64
128
256
512
1024
0Ͳ
10%
10Ͳ
20%
20Ͳ
30%
30Ͳ
40%
40Ͳ
50%
50Ͳ
60%
60Ͳ
70%
70Ͳ
80%
80Ͳ
90%
90Ͳ
100%
Total
s
N
um
be
ro
fp
at
ie
nt
s
(lo
g
sc
al
e)
TBSAofallograftrecipientscomparedtoall
patientsadmittedwithburninjuries
.
• Avoidance of creating additional 
wounds in the unwell patient.
• Added certainty that the burn wound is 
adequately debrided before using 
valuable autograft.
In New Zealand our allograft is stored by the 
New Zealand Blood service:
0
20000
0 10 20 30 40 50 60 70 80
A
re
a 
o
TBSA of Burn (%)
60%
50%
Allograftrecipients 1 2 5 10 11 4 7 4 2 0 46
AllburnpatientsadmittedtoMiddlemore
hospital 815 91 42 20 19 5 12 4 7 2 1017
TBSAofburn
A logarithmic relationship exists between TBSA 
(%) burn and total allograft requirement (cm2). 
Significant variations in the amount of allograft 
used exist. These most likely reflect rationale 
behind allograft use.
In our unit allograft is:
• Used for deep and full-thickness burns.Averageallograftusedperpatientperweek
1017 patients admitted with burns 2006 –2011:
• 55% of patients with burn injuries over 30% TBSA used 
allograft. 
• <1% of patients with burn injuries under 30% TBSA used 
allograft.
• Approximately 50,000cm2 are available 
immediately.
• If need exceeds 25,000cm2 an overseas 
order is placed to the USA.
• Orders can take upto 5 days to arrive.
Predicting allograft requirement is 
challenging. The only published predictive 
model1 is based principally on the ‘sandwich 
• Only used in a ‘sandwich-technique’ in 6% of 
operations.
• The ‘dressing-of-choice’ for temporary wound 
cover in 74 % of patients.
• Usually meshed.
0
2000
4000
6000
8000
10000
12000
0Ͳ10(n=1) 10Ͳ20(n=2) 20Ͳ30(n=3) 30Ͳ40(n=9) 40Ͳ50(n=9) 50Ͳ60(n=2) 60Ͳ70(n=3) 70Ͳ80(n=3) 80Ͳ90(n=1)
A
llo
gr
af
tR
eq
ui
re
d
(S
qC
m
)
TBSA(n=numberofpatients)
byTBSA(%)burn
Week1
Week2
Week3
Week4
2% 9%
Rationaleforusingallograft
Allograftusedasprimaryproductfor
f b d
grafting’ technique.
Aim
To produce a guide for the calculation of 
allograft ordering in acute burn care 
suitable for the model of care at the 
National Burn Centre y=1111.x
8000
10000
12000
m
2)
Predictingallograftrequirementforthefirst
weekofcare,byTBSA(%)burn
72%
4%
13%
temporarycoverageo  urnwoun
Allograftuselimitedbyinadequate
supply
Usedafterautograftfailed
Usedonlyonface
Usedafterabiosyntheticdressing
(BiobraneTM/EZ
dermTM/TransCyte®etc)onsmallarea
• 60% of all allograft used is used in the 1st week.
• Amount used decreases rapidly after this.
Method
• 5 year retrospective review (2006–2011).
• Included all adults admitted to the 
National Burn Centre of New Zealand 
with burn injuries on whom allograft was 
used as a temporary wound coverage. 
• Data sources included clinical 
records  electronic records  tissue bank 
Allograft index
Using Height and weight to estimate Body 
Surface area (Mosteller formula) an allograft 
index can be estimated
AI= Allograft used (cm2) / Burn size (cm2)
• Week one Allograft index = 0.62cm2
0.62cm2 of allograft is needed for every cm2 of burn
• Total allograft index = 0.9cm2
0
2000
4000
6000
0Ͳ10(n=1) 10Ͳ20(n=2) 20Ͳ30(n=3) 30Ͳ40(n=9) 40Ͳ50(n=9) 50Ͳ60(n=2) 60Ͳ70(n=3) 70Ͳ80(n=3) 80Ͳ90(n=1)
A
llo
gr
af
tr
eq
ui
re
d
(c
m
TBSABurn
Week one Allograft requirement (cm2) = 1111 x TBSA (%)
Conclusions
• Allograft is used in the care of the majority of patients with >30% TBSA burns.
• Variables in the amount of allograft needed include surgical technique and 
the rationale for allograft useage
• In our unit and with our practice we need (on average)
i  th  fi t k  0 62 2 / 2 f b  
, ,
records.
Demographics
• 46 patients… 14 (30%) female
32 (70%) male
• mean = 37 years… 16–76 years
• mean 44% TBSA 0 5%–80% TBSA • n e rs wee … . cm cm o urn
or 1,111 x TBSA (%) if height & weight unknown 
• 0.9cm2 / cm2 of burn for the durationReferences and Acknowledgements
1. Horner C. et al. Estimating the usage of allograft in the treatment of major burns. Burns. 2011 June;37(4):590-93. UK
2. Saffle J. Closure of the excised burn wound: temporary skin substitutes. Clin Plastic Surg 36 (2009) 627–641. USA
3. Chua A. et al. The impact of skin banking and the use of its cadaveric skin allografts for severe burn victims in Singapore. Burns. 2004 Nov;30(7):696-700. Singapore.
Thank you to… Vladimir Slyshkov at the Auckland Tissue Bank, Darren and Rebecca in the CMDHB Photography Department, Paul Baker, Burn Fellow
… .
• 15% mortality
 


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Predicting Allograft Requirement in the Management of Patients With Major Burn Injuries

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