Both dermal matrix and epidermis contribute to an inhibition of wound contraction

Contracture is a major detriment to functional recovery from large wounds. To determine the relative value of dermal replacement and epidermal coverag e in inhibiting wound contraction, five full-thickness wounds (all 5 x 5 cm (2)) were placed on the back of 8 swine and treated in the following manner : (1) open wound, (2) porcine acellular dermis (analogous to AlloDerm for h uman use), (3) porcine acellular dermis with epidermal autograft placed 7 d ays postwounding, (4) porcine acellular dermis with immediate epidermal aut ograft, and (5) conventional-thickness autograft. Scar dimensions and punch biopsies were taken at days 14 and 30 postwounding. The planimetry results demonstrated that wound contraction was significantly greater with the ope n wounds (group 1) than all other wounds with a dermal substitute. Furtherm ore, wounds with initial epidermal coverage had significantly less contract ion than unepithelialized wounds (14.8 +/- 1.1 cm(2) at day 14 in wound gro up 2 vs. 20.4 +/- 0.6 cm(2) in wound group 4; p < 0.05). Biopsy results rev ealed that wounds with initial epithelial coverage had the least amount of inflammation. These findings suggest that both dermal matrix and epidermal coverage contribute to an inhibition of wound contraction and that prompt e pithelial coverage appears to impede contraction by reducing inflammation.