title: Dermal substitution in acute burns and reconstructive surgery: a 12-year follow-up.
abstract: 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: 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.
authors.forename: Monica C T
authors.initials: MCT
authors.lastname: Bloemen
authors.forename: Michiel C E
authors.initials: MCE
authors.lastname: van Leeuwen
authors.forename: Niels E
authors.initials: NE
authors.lastname: van Vucht
authors.forename: Paul P M
authors.initials: PPM
authors.lastname: van Zuijlen
authors.forename: Esther
authors.initials: E
authors.lastname: Middelkoop
mesh_terms: D000208:Acute Disease; D002056:Burns / Q000601:surgery*; D002921:Cicatrix; D004548:Elasticity; D004890:Erythema / Q000175:diagnosis / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D008543:Melanins / Q000032:analysis; D017768:Skin, Artificial; D013499:Surface Properties
chemical_list: D008543:Melanins