What is the role of skin substitutes in the treatment of the burn patient?

Updated: Jan 10, 2018
  • Author: Robert L Sheridan, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Answer

Temporary skin substitutes provide protection from mechanical trauma, a vapor barrier, and a physical barrier to bacteria. [42] These membranes contribute to a moist wound environment with a low bacterial density that is consistent with optimal wound healing. Split thickness human allograft remains the optimal temporary skin cover.

A number of membranes have been developed to effect permanent wound coverage, including epidermal, dermal, and composite substitutes. A sheet of autologous epithelial cells can be grown from a full-thickness skin biopsy specimen. These can be useful in patients with massive injury, but they are very fragile, expensive, and provide unreliable definitive cover. Dermal analogs include Integra R (Integra Life Sciences, Plainsboro, NJ) and AlloDerm R (LifeCell Corporation, The Woodlands, Tex); both require an associated epithelial autograft. Integra R is a bilayer material with an inner layer of 2-mm thick collagen isolated from bovine tissue and chondroitin-6-sulfate and an outer layer of 0.009-in polysiloxane polymer with vapor transmission characteristics similar to skin. Allogenic dermis designed to be combined with a thin epithelial autograft, AlloDerm R is another promising dermal analog. Hopefully, an autologous composite skin substitute will ultimately be developed.


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