الفهرس | Only 14 pages are availabe for public view |
Abstract ADM materials are a potentially important tool for the burn surgeon in the acute and reconstructive setting. Many favorable reports have been published, but they are generally characterized by small sample sizes, limited objective testing, and retrospective analysis. There does appear to be some evidence for ADM application in patient populations in whom donor site availability (those with massive burns) or morbidity (children, the elderly) is a concern, but this has not been rigorously evaluated. Controlled prospective trials are necessary, particularly in the reconstructive arena, to identify optimization of ADM placement. Perhaps identification of manipulations that can facilitate revascularization (permitting use of even thicker materials) or the availability of more cost-effective xenogenic options will herald an even greater routine adoption of ADM in the management of the burn patient. Stressing the importance of the dermis in long-term durability and success rates, a number of investigators have evaluated a variety of materials as dermal substitutes or scaffolds on which a useful favorable neodermis is formed. These include products such as Integra (Integra Life Sciences Corp., Plainsboro, New Jersey), Matriderm (De Suwelack Skin and Health Care AG, Billerbeck, Germany), and others. Integra was one of the original ―dermal regeneration templates,‖ and this material has had success in settings both acute and reconstructive. However, this bilayer construct requires a two-stage approach, separated by two to four weeks. The newer product, Matriderm, has demonstrated successful take, favorable histologic findings, and improved scarring when applied in acute and reconstructive burn patients, compared to conventional grafting. Matriderm investigators were successful in achieving a one- stage application of dermal substitute and skin graft, and the reconstructive patients had improved elasticity in the short term. A recent 11-year follow-up revealed improved subjective scar assessment measurements and elasticity in the substituted group. Further description of these constructs is beyond the scope of this article, but they have received considerable application in acute burns and reconstructive surgery and are a valuable option for the burn surgeon. |