The Use Skin Substitutes in Burns and Non-Healing Wounds

Introduction: Deep burns and non-healing wounds occurring across joints or other critical areas provide a challenge in treatment and require adequate dermis to heal with limited contracture. With subsequent reconstruction being difficult to manage especially in patients with a paucity of donor sites, dermal substitutes can provide a useful reconstructive option to provide a more sufficient dermal base and help limit re-contracture. We report our experience, with the use of Alloderm and Integra dermal substitutes, in ninety-seven patients from 1998 to the present. Methods: Forty-eight patients had an Alloderm and split-thickness skin graft (STSG) composite graft placed to seventy-seven sites following burn scar contracture excisional release. All procedures were performed in a single stage where thick Alloderm is applied to the soft tissue release site and simultaneously covered with a thin STSG (.006-.008 inches). Forty-nine patients have had Integra placed to ninety-five sites for treatment of their acute burn injury (n=24), following burn scar contracture release (n=63), or treatment of a non-healing wound (n=8). All of the procedures were performed in two stages. Stage one included fascial excision of the acute wound, burn scar contracture, or non-healing area followed by placement of Integra and negative pressure wound therapy (NPWT) device. Stage two included removal of the silicone sheet from the Integra and gentle wound debridement with the Versajet Hydrosurgery System followed by placement of STSG (0.010 inches thick), and coverage with a NPWT device. Results: In our Alloderm series, forty-two of the forty-eight patients had successful wound healing. Four patients required additional surgical procedures due to re-contracture caused by non-compliance with physical and occupational therapy and two patients required additional procedures due to non-healing wounds. In our Integra series, thirty-seven patients with 83 sites had complete take of their Integra, six patients with six sites experienced a partial loss (20% or less) of their Integra, and six patients with six sites experienced complete loss of their Integra. All burn scar contracture release patients experienced greater functional active range of motion following release to burn scar contracture sites. Conclusions: The use of Alloderm and Integra as dermal substitutes represents a useful treatment algorithm for acute burns, burn reconstruction, and non-healing wounds. Their use has obviated the need for more complex flap reconstruction in many cases and allows for incisional or excisional release as needed without worrying about coverage.