Evaluation of the Use of Single Stage Dermal Substitutes in Acute and Chronic Wounds of the Hand

Document Type : Original Article

Authors

1 The Department of Plastic & Reconstructive Surgery, Al-Noor Specialist Hospital, Makkah, K.S.A.

2 The Department of Plastic & Reconstructive Surgery Ain Shams University, Cairo, Egypt**

3 The Department of Plastic & Reconstructive Surgery Ain Shams University, Cairo, Egypt

Abstract


Background: Skin substitutes were developed as an alternative
to skin grafts, especially for burn patients. Autologous
skin grafting is a painful procedure, and often the extent of
damaged skin is too large to be covered by autologous tissue
graft in existence of limited donor skin. Our aim of the study
was to evaluate the use of dermal substitutes in the treatment
of acute and chronic wounds of the hand and to establish an
applicable protocol of definitive wound management.
Methods: The study included 85 adult patients having
acute and chronic wounds of the hand. They were divided
into 2 groups Group (A): Fifty-five Patients treated with
Single-layer dermal substitutes and STSG applied to the
wound bed in a one-stage procedure, group (B): Thirty Patients
treated with skin grafting alone. Scar Evaluation was done
by Pre-& post-operative photography. The Vancouver Scar
Scale, Histopathological examination at 45 days postoperatively,
Range of motion and Patient satisfaction.
Results: Statistical analysis showed significant differences
between the two groups.
Conclusion: A true “skin substitute” would act like an
autologous skin graft in adhering to the wound bed while
providing the physiological and mechanical functions of
normal skin. The use of dermal substitutes represents a promising
treatment for acute burns and chronic wounds.

Keywords

Main Subjects


1- Dieckmann C., Renner R., Milkova L., et al.: Regenerative
medicine in dermatology: biomaterials, tissue engineering,
stem cells, gene transfer and beyond. Exp. Dermatol.
Aug., 19 (8): 697-706. PMID: 20545761, 2010.
2- Boyce S.T.: Design principles for composition and performance
of cultured skin substitutes. Burns, 27: 523-
533, 2001.
3- Chern P.L., Baum C.L. and Arpey C.J.: Biologic dressings:
Current applications and limitations in dermatologic
surgery. Dermatol. Surg. Jun., 35 (6): 891-906. PMID:
19397669, 2009.
4- Buncke G.M., Buntic R.F. and Romeo O.: Pediatric mutilating
hand injuries. In: Dellapena D., ed. Hand Clinics.
Philadelphia: WB Saunders, 121-131, 2003.
5- Askari M., Fisher C., Weniger F.G., et al.: Anticoagulation
therapy in microsurgery: A review. J. Hand. Surg., 31A:
836-846, 2006.
6- Levin L.S. and Cooper E.O.: Clinical use of anticoagulants
following replantation. J. Hand. Surg., 33A: 1437-1439,
2008.
7- Halim, Ahmad Sukari, Khoo, Teng Lye, Jumaat, Shah, et
al.: Biologic and synthetic skin substitutes: An overview.
Indian J. Plast. Surg. Sep., 43 (Suppl): S23-S28. [PubMed:
21321652], 2010.
8- Moiemen N., Yarrow J., Hodgson E., et al.: Long-term
clinical and histological analysis of Integra dermal regeneration
template. Plast. Reconstr. Surg., 127 (3): 1149-
54. [PubMed: 21088647], 2011.
9- Shirley R., Teare L., Dziewulski P., Frame J., Navsaria
H. and Myers S.: A fatal case of toxic shock syndrome
associated with skin substitute. Burns. Sep., 36 (6): e96-
8. [PubMed: 20092950], 2010.
10- Ryssel H., Gazyakan E., Germann G. and Ohlbauer M.:
The use of MatriDerm in early excision and simultaneous
autologous skin grafting in burns: A pilot study. Burns
34: 93-97, 2008.
11- Truong A.T., Kowal-Vern A., Latenser B.A., Wiley D.E.
and Walter R.J.: Comparison of dermal substitutes in
wound healing utilizing a nude mouse model. J. Burns
Wounds, 4: 72-82, 2005.
12- Iorio M.L., Shuck J. and Attinger C.E.: Wound healing
in the upper and lower extremities: A systematic review
on the use of acellular dermal matrices. Plast. Reconstr.
Surg. Nov., 130 (5 Suppl 2): 232S-41S. [PubMed:
23096978], 2012.
13- Jacoby S.M., Bachoura A., Chen N.C., Shin E.K. and
Katolik L.I.: One-stage Integra coverage for fingertip
injuries. Hand, 1-5. [PubMed: 24426886], 2013.
14- McCauley R.L.: Long term results of acellular dermal
matrix (AlloDerm) in pediatric burn reconstruction. J.
Burn. Care. Rehabil., 20 (1) (pt 2): S213, 1999.
15- Motykie G.D., Washington W., Sanford A., Herndon N.
and Wolf S.E.: Outcomes of AlloDerm grafting in acute
severe thermal injuries. J. Burn. Care. Rehabil., 22: S128,
2001.
16- Chaudhari S., Roggy D., Zieger M. and Sood C.R.: Use
of Allo- Derm to prevent recontracture following burn
scar contracture release. J. Burn. Care. Res., 28 (2) (Suppl):
S85, 2007.
17- Askari M., Fisher C., Weniger F.G., et al.: Anticoagulation
therapy in microsurgery: A review. J. Hand. Surg., 31A:
836-846, 2006.
18- Sun Y., Li C. and Wang C.: Study and application of
acellular dermal matrix transplantation combined with
thin split-thickness autoskin grafting. Chin. J. Plast. Surg.,
14: 370-372, 1998.
19- Rizzo M.: The use of Integra in hand and upper extremity
surgery. J. Hand. Surg. Am. Mar., 37 (3): 583-6. [PubMed:
22209210], 2012