title: [The role of skin substitutes in the surgical treatment of extensive burns covering more than 60 % of total body surface area. A review of patients over a 10-year period at the Tours University Hospital].
abstract: BACKGROUND
  Progress in intensive care and surgery has made it possible to significantly improve the survival of victims with burns over 60% of total body surface area (TBSA). Coverage of the excised areas of these patients can be difficult when there is a shortage of skin donor sites; then the role of skin substitutes can be important.
  
  
  METHODS
  This retrospective study included patients with burns covering more than 60% TBSA and treated at the Tours University Hospital over a period of 10 years. Patients who died during the first week or who presented superficial burns were excluded. The various substitutions means to temporarily or permanently replace the cutaneous barrier are presented. The biological dressings associated with grafts expanded by six according to the sandwich technique, allografts and xenografts, widely expanded postage stamp skin grafts using a modified Meek technique (Humeca(®)), temporary cutaneous substitutes such as Biobrane(®) and skin substitutes colonized by autologous cells (Integra(®)) are presented.
  
  
  RESULTS
  Forty-four patients were admitted. Self-immolations represented 52% of the cases. Twenty-one patients were treated with Integra(®), 5 with Biobrane(®), 17 with sandwich grafts and 4 with postage stamp skin grafts. Integra(®) was widely used when donor sites were insufficient. The mean number of surgical procedures per patient was 8.4. The mean duration of hospitalization was 155 days. Twenty-four patients survived until the end of treatment. Eighteen patients died during the first week before any surgery could be performed. Two patients died at the end of treatment. The overall survival rate was 55%. It was 92% for patients who survived the first week. The principal sequel were functional (hand, cervical, thoracic and axillary contractures) and aesthetic (face and hands). Associated treatments were pressotherapy, physical therapy, ergotherapy and thermal water therapy.
  
  
  CONCLUSIONS
  By temporarily replacing the cutaneous barrier in the absence of sufficient donor sites, skin substitutes make it possible to increase the survival of patients with very extensive burns and to optimize their treatment.
authors.affiliation: Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France.
authors.forename: J
authors.initials: J
authors.lastname: Lamy
authors.affiliation: Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France.
authors.forename: A-H
authors.initials: AH
authors.lastname: Yassine
authors.affiliation: Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France.
authors.forename: A
authors.initials: A
authors.lastname: Gourari
authors.affiliation: Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France.
authors.forename: N
authors.initials: N
authors.lastname: Forme
authors.affiliation: Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France; Cabinet, 33, rue de la Tour, 75016 Paris, France. Electronic address: zakinegilbert@yahoo.fr.
authors.forename: G
authors.initials: G
authors.lastname: Zakine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002056:Burns / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005602:France / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016038:Skin Transplantation; D017768:Skin, Artificial; D055815:Young Adult
keywords: Brûlure; Burn; Dermal substitute; Excision cutanée; Greffe de peau; Skin excision; Skin graft; Substituts dermiques