title: Graft survival and effectiveness of dermal substitution in burns and reconstructive surgery in a one-stage grafting model.
abstract: Survival of the autograft and objective parameters for scar elasticity were evaluated after dermal substitution for acute burns and reconstructive surgery. The dermal substitute, which was based on bovine type I collagen and elastin-hydrolysate, was evaluated by intraindividual comparison in a clinical trial. The substitute was applied in a one-step procedure in combination with a split-thickness autograft. This treatment was compared with the conventional treatment, the split-thickness antograft. After 1 week, the percentage of autograft survival was assessed. The Cutometer SEM 474 was used to obtain objective measurements of skin elasticity parameters 3 to 4 months postoperatively. Forty-two pairs of wounds (31 patients, age 32.9 +/- 19.3 years; burned surface area, 19.8 +/- 14.5 percent) were treated because of acute burns. Reconstructive surgery was performed on 44 pairs of wounds (31 patients, age 33.9 +/- 17.5 years). Autograft survival was not altered by the substitute for reconstructive wounds, although a slight but significant reduction (p = 0.015) was established in the burn category for substituted compared with nonsubstituted wounds. However, the necessity for regrafting was not increased by substitution. Cutometer measurements of reconstructive wounds with a dermal substitute demonstrated a significant increase of pliability (50 percent, p < 0.001), elasticity (defined as immediate extension, 33 percent, p = 0.04), maximal extension (33 percent, p = 0.002), and immediate retraction (31 percent, p = 0.01), as compared with nonsubstituted wounds. After burn surgery, no improvement was found for the different elasticity parameters. Dermal substitution in a one-stage grafting model seems feasible with respect to graft survival. Skin elasticity was considerably improved by the collagen/elastin dermal substitute after reconstructive surgery.
authors.affiliation: Burn Center, Department of Surgery, Red Cross Hospital, Beverwijk, The Netherlands. bwcpzl@rkz.nl
authors.forename: P P
authors.initials: PP
authors.lastname: van Zuijlen
authors.forename: A J
authors.initials: AJ
authors.lastname: van Trier
authors.forename: J F
authors.initials: JF
authors.lastname: Vloemans
authors.forename: F
authors.initials: F
authors.lastname: Groenevelt
authors.forename: R W
authors.initials: RW
authors.lastname: Kreis
authors.forename: E
authors.initials: E
authors.lastname: Middelkoop
mesh_terms: D000328:Adult; D002056:Burns / Q000601:surgery*; D002921:Cicatrix / Q000503:physiopathology; D004548:Elasticity; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D008297:Male; D012086:Reoperation; D016038:Skin Transplantation; D017768:Skin, Artificial; D014182:Transplantation, Autologous; D014945:Wound Healing / Q000502:physiology