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Abstract
The application of dermal substitutes in deep partial and full-thickness burn wounds
in a two-stage procedure prior to skin grafting has become increasingly popular. Synchronous
application of dermal substitutes and skin graft has not yet been established as a
standard procedure. In a consecutive study 20 wounds in 10 patients with severe burns
(age 49.5+/-16.2 years; TBSA 45.6+/-14.5%) were treated with either simultaneous transplantation
of Matriderm, a bovine based collagen I, III, V and elastin hydrolysate based dermal
substitute and split-thickness skin grafting (STSG), or STSG alone after appropriate
excision of the burn wound. The study was designed as a prospective intra-individual
comparative study. After 1 week all wounds were assessed for the percentage of autograft
survival. Autograft survival was not altered by simultaneous application of a dermal
matrix (p=0.015). Skin elasticity was measured after 3-4 months with the Vancouver
Burn Skin Score (VBSS). The VBSS demonstrated a significant increase of elasticity
in the group with dermal substitutes (p=0.04) as compared with non-substituted wounds
for sheet autograft, but not for meshed autograft (p=0.24). From this pilot study
it can be concluded that simultaneous application of a dermal matrix is safe and feasible,
yielding significantly better results with respect to skin elasticity. Skin elasticity
was considerably improved by the collagen/elastin dermal substitute Matriderm in combination
with sheet autograft.