Journal Article

73 A 10 Year U.K. Experience of Dermal Scaffolds in the Management of Burns

D Markeson, T Pezas and S Ghosh

in Journal of Burn Care & Research

Volume 39, issue suppl_1, pages S41-S42
Published in print April 2018 | ISSN: 1559-047X
Published online April 2018 | e-ISSN: 1559-0488 | DOI: http://dx.doi.org/10.1093/jbcr/iry006.076
73 A 10 Year U.K. Experience of Dermal Scaffolds in the Management of Burns

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  • Medicine and Health
  • Acute Medicine
  • Emergency Medicine
  • Critical Care
  • Surgery

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Abstract

Introduction

Dermal scaffolds have been available since the mid 1990’s and one of their principal targets has been to improve the functional and cosmetic appearance of scars following burns. In our unit we have extensive experience of 2 of these scaffolds, Matriderm® and Integra® as well as some preliminary results with the more recently developed dermal scaffold Pelnac™ and present our experiences and evolution in practice with these materials over a 10 year period from 2007 to 2017.

Methods

We reviewed our departmental database, created in 2007, for all patients with burns treated either in the acute or delayed setting using a dermal scaffold, with all procedures performed by the senior author (SG). Outcomes were assessed by patients and clinicians using the patient and observer scar scale (POSAS), a validated, internationally accepted scar assessment scale. Complications, total number of procedures and time to healing were also examined. In our practice Matriderm® was predominantly used as a single stage matrix in patients with acute burns whilst Integra® was used for both primary and secondary burns reconstruction.

Results

59 patients were managed with Matriderm®, 22 patients with Integra® and 4 using Pelnac™. Age ranged from 12 to 84 years and total burn body surface area from 0.5% to 55%. Body parts involved included face, torso, upper limbs and lower limbs in the Matriderm® group and torso, upper and lower limbs in the Integra® group. Complications included hematoma, partial loss and infection with no statistical difference across both groups. There was no statistically significant difference in POSAS score or complications between the 2 main study groups (Matriderm® and Integra®) although the number of operations required for patients managed with Integra® was on average higher than Matriderm® or Pelnac™. Outcomes for all scaffolds varied with ethnic group, depth of burn and whether used as a primary or secondary reconstructive method. The presence of preexisting hypertrophic scarring was an important indicator for poor outcomes.

Conclusions

Integra® and Matriderm® have an important role in the management of acute burns and the resurfacing of poorly healed burn scars. Whilst Matriderm® and Pelnac® have the advantage of being single stage dermal matrices, resulting in less operations, all 3 dermal scaffolds produce satisfactory scarring for burns from the patient and surgeons perspective.

Applicability of Research to Practice

From our data we have optimized the use of dermal scaffolds for the management of acute burns and post-burn scarring and provide insights into the factors which influence decision making and final outcomes.

Journal Article.  0 words. 

Subjects: Medicine and Health ; Acute Medicine ; Emergency Medicine ; Critical Care ; Surgery

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