title: Effective use of Biobrane as a temporary wound dressing prior to definitive split-skin graft in the treatment of severe burn: A retrospective analysis.
abstract: OBJECTIVE
  To report on the use of Biobrane, a synthetic skin substitute, as a temporary wound cover in patients with severe burn. In particular we wished to examine the role of Biobrane in maintaining a healthy wound bed following surgical excision and identify factors associated with regrafting.
  
  
  METHODS
  A retrospective case series review was performed on patients with severe burns (≥ 20% TBSA), admitted to the Victorian Adult Burns Service, in Melbourne, from January 2009 to June 2012. Logistic regression analysis was performed to identify factors associated with regrafting.
  
  
  RESULTS
  Out of 58 patients with median %TBSA burn of 30%, 22 patients (37.9%) required regrafting of at least one area previously treated with Biobrane and split-skin graft. On univariate analysis, need for regrafting was significantly associated with increasing %TBSA (OR 1.04, 95% CI: 1.01-1.08; p=0.02); and after multivariate analysis to adjust for this effect, hospital LOS (OR 1.04, 95% CI: 1.02-1.07; p=0.001); total operative time (OR 1.16, 95% CI; 1.06-1.28; p=0.002) and total number of surgeries (OR 1.69, 95% CI: 1.27-2.26, p<0.001) remained significantly associated with regrafting. Age, gender, time to surgical debridement and Biobrane application, and anatomical region were not found to be associated with regraft.
  
  
  CONCLUSIONS
  At our institution, Biobrane has emerged as an alternative option to maintain a healthy wound bed after burn excision and prior to grafting. Our small number of extensive graft failures, small areas of regrafting and low infection rate following Biobrane application reflects our current experience with Biobrane. Precise indications and most appropriate methods for Biobrane use are yet to be established.
authors.affiliation: Victorian Adult Burns Service, Department of Surgery, Monash University, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia.
authors.forename: Hannah
authors.initials: H
authors.lastname: Tan
authors.affiliation: Victorian Adult Burns Service, School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia. Electronic address: J.Wasiak@alfred.org.au.
authors.forename: Jason
authors.initials: J
authors.lastname: Wasiak
authors.affiliation: Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Australia.
authors.forename: Eldho
authors.initials: E
authors.lastname: Paul
authors.affiliation: Victorian Adult Burns Service, Department of Surgery, Monash University, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia.
authors.forename: Heather
authors.initials: H
authors.lastname: Cleland
mesh_terms: D000328:Adult; D001830:Body Surface Area; D002056:Burns / Q000473:pathology / Q000628:therapy*; D020099:Coated Materials, Biocompatible / Q000627:therapeutic use*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003646:Debridement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011091:Polyesters / Q000627:therapeutic use; D011095:Polyethylenes / Q000627:therapeutic use; D012086:Reoperation; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: C117408:Acticoat; C042816:Biobrane; D020099:Coated Materials, Biocompatible; D011091:Polyesters; D011095:Polyethylenes
keywords: Biobrane; Severe burn; Temporary wound closure