Artificial Dermis for Major Burns

Abstract

This communication presents an 11-center prospective randomized trial using the artificial dermis invented by Burke and Yannas. Patients with life-threatening burns who underwent primary excision and grafting within 7 days of injury had comparable sites randomized to receive either the artificial dermis (study site) or the investigator's usual skin grafting material (control site). Control materials were autograft, allograft, xenograft, or a synthetic dressing. Epidermal grafts were applied to the study site during a second operation, and surviving patients were followed for 1 year after grafting. One hundred thirty-nine sites on 106 patients were studied. Mean burn size was 46.5 +/- 15% mean total body surface (TBSA). Overall mortality was 13%, and mean hospital stay was 68 +/- 45 days. Median artificial dermis take was 80% compared with 95% for all comparative sites, but the take was equivalent to that of all nonautograft control materials. Results with the artificial dermis improved slightly as the investigators became more familiar with the material. Donor site thickness for the study site averaged .006'' +/- .002'' compared to .013'' +/- .018'' for control (p less than .0001) and the epidermal donor site healed an average of 4 days sooner (10 +/- 6 vs. 14 +/- 8 days) (p less than .0001). As the wounds matured during the first year, both patients and surgeons felt that both sites became more comparable in appearance and function. At the completion of the study, there was less hypertrophic scarring of the artificial dermis, and more patients preferred the artificial dermis to the control graft. Artificial dermis with an epidermal graft provides a permanent cover that is at least as satisfactory as currently available skin grafting techniques, and uses donor grafts that are thinner and donor sites that heal faster.

Preparation and characterization of a collagen/chitosan/heparin matrix for an implantable bioartificial liver

“…It is known that collagen is a structural protein that is said to be one of the most suitable materials for constructing artificial substitutes for diseased or damaged tissues and organs [15]. Collagens combined with proteoglycans have been reported to be metabolically stable when implanted in vivo and have been used as artificial skin, which accelerates the wound healing [16]. Chitosan, an amino-polysaccharide (poly(1,4-D-glucosamine)) derived from chitin by deacetyation, has been widely applied in biomedical applications, such as wound dressings and drug-delivery systems [17,18] on account of its non-toxic and biocompatible nature.…”

Tissue Engineering of Skin

“…Multi-center randomized clinical trials of 106 patients compared matched pairs of wounds covered with (a) artificial dermis with wounds covered with (b) meshed STSGs, allografts, xenografts, or synthetic dressings. The artificial dermis was sutured or stapled in place, and, following vascular ingrowth, usually in 14 days, was grafted with epidermis taken at the thinnest dermatome setting that would produce a translucent graft with minimal dermis attached (Heimbach et al, 1988). The following were the major advantages of this artificial skin with thin epithelial grafts as compared with meshed split-thickness skin grafts or allografts:…”

A Short Commentary about Efficacy of an Flowable Matrix in the Treatment of Diabetic Foot Ulcers

“…They reduced contraction and scar formation with improvement of extracellular matrix remodeling and elastin regeneration [7,8]. In trials in burned patients was demonstrated significant skin regeneration using the same scaffold [9,10]; a limited numbers of randomized controlled trials that study skin substitutes have been published, but the evidence of studies is encouraging. Among skin substitutes, the dermal substitutes can be manufactured in high quantity with low price, easy to keep and to use.…”