Intermediate Skin Substitutes Are Unnecessary in Small (<10% TBSA) Burns

Abstract

The use of intermediate skin substitutes between debridement and final autografting is routine for many practitioners. Materials such as xenografts and allografts have been promoted to help with wound coverage before autografting. However, there is limited data for their use in relatively small burn wounds (<10% TBSA). In this study, we analyzed the outcomes of 100 consecutive patients who underwent autografting for burns <10% TBSA at our American Burn Association-verified burn unit in the absence of intermediate skin substitute use. We retrospectively analyzed 100 patients who underwent split thickness skin graft autografting for burns <10% TBSA between November 2017 and June 2019. No patients were treated with intermediate skin substitutes. Analysis included basic demographics, comorbidities, TBSA burned, mechanism of burn, time to grafting, if grafting was performed in a single procedure or staged, graft loss (>50% graft failure), and time to complete healing (no further wound care required). Twelve patients (12%) had unpredictable graft beds, and their procedure was staged. These patients underwent surgical debridement and were dressed in antimicrobial dressing for an average of 5 days before autografting. No patients had intermediate skin substitutes between procedures. Eighty-eight patients (88%) were debrided and grafted in a single stage. In the staged group, there was a 0% rate of graft failure compared with 9.1% rate of graft failure in the primarily grafted group (P = .004). There was a similar length of stay and time to complete healing in the staged group and primarily grafted group (P = .496 and P = .571). There was a significantly shorter time from injury to first procedure between the staged group and the primarily grafted group (8.7 days and 13.5 days, P = .014). In the eight instances of graft failure, infection or inadequate debridement was the cause. Seven of these eight cases required further surgical intervention. Intermediate skin substitutes are an unnecessary step in grafting small burns. These add only complexity and cost to patient care. Many patients can be debrided and grafted in a single stage. Debridement alone with delayed grafting is a highly effective surgical method when the wound bed is not suitable for immediate grafting. The use of intermediate skin substitutes in small burns requires further investigation as this study finds low benefit for this product.

Mesenchymal stem cells paracrine proteins from three‐dimensional dynamic culture system promoted wound healing in third‐degree burn models

“…Third‐degree burn refers to the burn of the full‐thickness skin, including epidermis deep dermis and total degeneration and necrosis of the skin appendages, and even reach the subcutaneous, muscular, and skeletal levels 2 . In clinical practice, large area third‐degree burn, total body surface area (TBSA) greater than 30%, treatments usually require skin‐grafting, while small area third‐degree burn (less than 10% TBSA) is more commonly seen and could be self‐repairing 3,4 . But still, varying degrees of scarring and loss of appendages after third‐degree burn wound healing could cause severe contracture, painful itching, and loss of skin function 5 .…”

“…2 In clinical practice, large area third-degree burn, total body surface area (TBSA) greater than 30%, treatments usually require skin-grafting, while small area thirddegree burn (less than 10% TBSA) is more commonly seen and could be self-repairing. 3,4 But still, varying degrees of scarring and loss of appendages after third-degree burn wound healing could cause severe contracture, painful itching, and loss of skin function. 5 Therefore, minimizing wound scarring and recovery of skin appendages are important issues for the treatment of third-degree burn.…”