**3. Technical aspects of skin banks**

Human skin storage started at the beginning of the XX century, following the description of skin transplant after its refrigeration, but modern skin banks began in 1949, after the creation of the Tissue Bank of the United States Marine. However, Tissue Banks arrived in developing countries three decades later than the developed world [37–43].

According to the American Association of Tissue Banks, a Tissue Bank is defined as "an entity that provides or is dedicated to one or more services related with tissues from live or dead persons, with a transplant objective. These services include obtaining authorization and/or informed consent, evaluating donor eligibility, recuperation, harvest, acquisition, processing, storage, labeling, distribution, and dispensing tissues" [41].

Skin donation, a source of SA and CTSCA, is mainly influenced by cultural and religious factors but regulated by specific laws depending on each country and can be divided into seven big stages: 1) donor selection, 2) procurement, 3) processing, 4) storage, 5) radiation, 6) distribution, and 7) clinical use [42–45].

#### **3.1 Donor selection**

The appropriate donor selection allows the generation of safe tissues, primarily reducing the risk of disease transmission during the CTSCA transplant [46].

When deciding the body contour surgery, mainly abdominoplasty, patients are invited to be donors of redundant skin flaps, which would otherwise be a surgical waste. A health survey, verification of exclusion criteria absence, and routine laboratory tests related to organ and tissue donation (hepatitis B surface antigen, hepatitis C antibodies, HIV antibodies, VDRL, HTLV I and II, Chagas, and cytomegalovirus) (**Table 2**) are done. As previously mentioned, most exclusion criteria for organ and tissue donation are usually inexistent in the live donor submitted to elective surgery.

#### **3.2 Procurement**

The skin procurement takes place in the surgical ward, with the same surgical team and time of the body contour surgery, respecting all the asepsis and antisepsis


**Table 2.** *Laboratory tests.*

*Laboratory.*

*Banks of Cryopreserved Skin from Live Donors and Total Skin Allografts in the Surgery of… DOI: http://dx.doi.org/10.5772/intechopen.104451*

#### **Figure 3.**

*A. Patient with intermediate and deep burns. B. Burnt patient following a CTSCA use, immediate postoperative. C. Burnt patient, 14 days postoperative with CTSCA coverage.*

measures. In the particular case of abdominoplasty (the most frequent CTSCA source), the redundant skin is demarcated in a transverse-infra umbilical-ellipse form, followed by dissection and resection of the skin flap. The abdominoplasty is developed independently, and the skin procurement is done in a separate surgical table.

The subcutaneous component of the cutaneous-subcutaneous flap is resected using scissors, exposing the deeper dermis (**Figures 3** and **4**). Three tissue samples are taken for current (aerobic), anaerobic, and fungal cultures. Procured skin is placed in a sterile recipient with 500 cc of physiological serum, Cloxacillin 1 g, and Gentamicin 80 mg, hermetically closed, promoting the complete skin submersion. The same receipt is saved in a double sterile bag and stored at 2 and 8°C until processing. All the information needed to guarantee the traceability and biosecurity of the tissues is consigned.

#### **3.3 Processing**

The skin processing is subdivided into three stages: 1) cutting, b) cleaning, and c) packing/labeling, all of them take place in a clean room, with rigorous aseptic technique and a biosecurity cabinet.

#### *3.3.1 Cutting*

Once the skin flap is measured (length, width, and thickness), cuts using a scalpel and scissors are done according to the requested or standardized measures (**Figure 2**). Standard measures are 10 x 10 cm, 10 x 5 cm, and 5 x 5 cm. According to the redundant skin, other dimensions cuts are done, and the smallest size accepted is 2 x 2 cm.

**Figure 4.** *CTSCA processing flow chart.*
