Use of SureDerm(TM) in the Skin Graft of Full Thickness Burns

PURPOSE: Split-thickness skin grafts (STSG), as a treatment of full thickness burn have played a significant role in re-surfacing to date. The major disadvantage of traditional STSG is related to donor site morbidity, including scar formation and cosmetic changes. SureDerm(TM) is acellular human dermis, which is intended for the repair or replacement of damaged soft tissue. Then, we present our experience of using SureDerm(TM) as a tool for the skin graft of full thickness burns. METHODS: We reviewed the medical records of 20 patients treated in our burn center who received SureDerm(TM) graft with thin STSG in full thickness burns since November 2006 to October 2008. RESULTS: SureDerm(TM) was used with thin STSG (range 0.006~0.008 inches) concurrently. Thickness of SureDerm(TM) was 0.2~0.4 mm and the type of SureDerm(TM) was meshed. The average size of SureDerm(TM) used in the burn patients was 329.6 cm2 (32~1,384). All burn areas grafted SureDerm(TM) were full thickness burns and the locations were upper and lower extremities including joints (8 and 6 cases), trunk (3 cases), ankle (2 cases), and axilla (1 case). Each SureDerm(TM) grafted area had more than 95% take-rate. No complications were observed except 1 case of partially infected STSG. The mean follow up period was 8.7 months (1~17), and the assessment of scars, which had more than six months follow up periods was performed by Modified Vancouver Scar Scale and the results were good. CONCLUSION: SureDerm(TM) can be used as a dermal substitute for the treatment of full thickness burns and the result seems to be good cosmetically and functionally while it solves donor site morbidity followed by autograft.

Cultured Epithelial Autografts (Sheet & Suspension Type)

The treatment application of cultured epithelial autograft (CEA) is the only selected treatment method when performing skin graft for treating massive burns over 70 to 80%. Clinically 2 types of CEA, sheet type and suspension type, are currently available in Korea. The sheet type of CEA, Holoderm(R), was commonly used since no other CEA were available. Since the recent introduction of the suspension type, Keraheal(R), the suspension type is also clinically used. Although 2 types are different in type of forms provided but both types are clinically effective for increasing survival rate of massive burn patients. The early treatment method of massive burn is selected based on the rage of burns using Warden or Parkland Formula. The escharectomy is performed within 3 to 7 days of burn then cadaver skin allograft is applied immediately. At this time, the full thickness skin biopsy in the size of 2x3 cm is obtained from non burned area such as axilla, inguinal or abdomen. Then the skin biopsy is sent to the labs. The length of culturing time is less than 3 weeks for Holoderm(R) and around 2 weeks for Keraheal(R). Holoderm(R) is provided as a sheet type. It is simply applied over 1:3~1:6 meshed skin autograft and fixed with staplers together with skin autograft. In the other hand, the suspension type of CEA, Keraheal(R), is provided in a glass vial and sprayed over 1:3~1:6 meshed skin autograft using Tissomat(R). The fibrin sealant is sprayed after application of Keraheal(R) as a fixation of suspension CEA sprayed. Extra wound care is necessary even after both types of CEA are successfully taken since CEA applied regions are much more fragile than those regions applied skin autograft only. The treatment methods of applying cadaver skin allograft and culture epithelial autograft (CEA) are the most advanced treatments available for increasing survival rate of massive burn patients. The sheet type and suspension type of CEA show difference in type of forms provided but they both show successful take rate that enhance the burn treatment. We suspect that both types of CEA still need ongoing efforts and researches to enhance their advantages and eliminate disadvantages to increase the efficacy that can promote wound healing process of massive burn patients.