title: Five years of experience using a dermal substitute: indications, histologic studies, and first results using a new single-layer tool.
abstract: BACKGROUND
  Dermal substitutes have been used in Europe since 1996 as a mean of reconstructing the dermal layer.
  
  
  OBJECTIVE
  To introduce the dermal substitute as a dual-stage reconstructing procedure using the dual-layer version and as a single-stage procedure, combining the single layer with a skin graft to achieve immediate closure. Our further objective was to evaluate the persistence of a commercial dermal substitute in the host's dermal layer using serial histologic studies.
  
  
  METHODS
  The dermal substitute used was a membrane made using a porous coprecipitate of type I bovine collagen and glycosaminoglycan organized in a three-dimensional structure that allows the host's cell to migrate into it. It is available in a double-layer structure, covered by a silicone sheet, and in a single-layer structure without silicon.
  
  
  CONCLUSIONS
  We describe the dermal substitute indications in dermatologic surgery and our first results with the single layer as a single-stage procedure with an 80% to 100% take rate. Our histological studies of both products show their perfect integration and the persistence of the peculiar three-dimensional structure (neodermis) 5 years from implantation of the dual-layer dermal substitute.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Ospedale di Cattinara, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Trieste, Italy. giovanni.papa@aots.sanita.fvg.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Papa
authors.forename: Martina
authors.initials: M
authors.lastname: Pangos
authors.forename: Nadia
authors.initials: N
authors.lastname: Renzi
authors.forename: Vittorio
authors.initials: V
authors.lastname: Ramella
authors.forename: Nicola
authors.initials: N
authors.lastname: Panizzo
authors.forename: Zoran Marij
authors.initials: ZM
authors.lastname: Arnez
authors.forename: Arnež Zoran
authors.initials: AZ
authors.lastname: Marij
mesh_terms: D002809:Chondroitin Sulfates / Q000737:chemistry / Q000627:therapeutic use*; D003094:Collagen / Q000737:chemistry / Q000627:therapeutic use*; D006801:Humans; D019651:Plastic Surgery Procedures; D017768:Skin, Artificial; D016896:Treatment Outcome
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen