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Dermal Substitution in Acute Burns and Reconstructive Surgery: A 12-Year Follow-Up

Bloemen, Monica C. T. M.D.; van Leeuwen, Michiel C. E. B.Sc.; van Vucht, Niels E. B.Sc.; van Zuijlen, Paul P. M. Ph.D., M.D.; Middelkoop, Esther Ph.D.

Plastic and Reconstructive Surgery: May 2010 - Volume 125 - Issue 5 - p 1450-1459
doi: 10.1097/PRS.0b013e3181d62b08
Reconstructive: Trunk: Original Articles

Background: Application of dermal substitutes has been reported to improve the outcome of burns. However, the long-term effectiveness of dermal substitutes has not been investigated objectively. The aim of this study was to evaluate long-term effectiveness of a collagen-elastin dermal substitute in acute and reconstructive burn surgery.

Methods: From 1996 to 1998, an intraindividual comparison was carried out between a dermal substitute with a split-skin graft and a split-skin graft alone in patients with acute and reconstructive wounds. In this follow-up, scar elasticity, vascularization, pigmentation, and surface roughness were determined objectively. In addition, a subjective scar assessment was performed.

Results: In 46 patients, 69 pairs of substituted and conventionally treated sites were measured, consisting of acute and reconstructive burn scars. In reconstructive scars, one surface roughness parameter was significantly better in substituted scars. Subjective assessment in acute and reconstructive burn scars showed several statistically significant differences in favor of substituted scars, such as pliability, relief, and the general observer score. Elasticity measurements showed higher scores for substituted scars, although the difference was not statistically significant. For the subcategory of scars treated with a largely expanded meshed skin graft, a significantly higher elasticity was found for the substituted area.

Conclusion: In this first long-term and objective follow-up of dermal substitution, the authors found improved scar parameters in both acute and reconstructive wounds treated with the substitute, indicating a long-lasting effect on scar quality.

Beverwijk and Amsterdam, The Netherlands

From the Association of Dutch Burn Centers; the Burn Center and the Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital; the Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center; and the Department of Plastic, Reconstructive, and Hand Surgery, VU University Medical Center.

Received for publication September 25, 2009; accepted November 12, 2010.

Nominated for the Young Investigator's Award of the 5th Joint Meeting of the European Tissue Repair Society, in Limoges, France, August 25 through 29, 2009, and the Best Poster Award of the 13th European Burns Association Congress, in Lausanne, Switzerland, September 2 through 5, 2009.

Disclosures: The original clinical trial was supported financially by grants from the Technology Foundation and the Dutch Organization for Scientific Research. The follow-up study was supported financially by the Dutch Burns Foundation. The authors have no conflicts of interest to report.

Esther Middelkoop, Ph.D. Association of Dutch Burn Centers; Postbus 1015; 1940 EA Beverwijk, The Netherlands; e.middelkoop@vumc.nl

©2010American Society of Plastic Surgeons