Graft survival and effectiveness of dermal substitution in burns and reconstructive surgery in a one-stage grafting model

Survival of the autograft and objective parameters for scar elasticity were evaluated after dermal substitution for acute burns and reconstructive sur gery. The dermal substitute, which was based on bovine type I collagen and elastin-hydrolysate, was evaluated by intraindividual comparison in a clini cal trial. The substitute was applied in a one-step procedure in combinatio n with a split-thickness autograft. This treatment was compared with the co nventional treatment, the split-thickness autograft. After 1 week, the perc entage of autograft survival was assessed. The Cutometer SEM 474 was used t o obtain objective measurements of skin elasticity parameters 3 to 4 months postoperatively. Forty-two pairs of wounds (31 patients, age 32.9 +/- 19.3 years; burned surface area, 19.8 +/- 14.5 percent) were treated because of acute burns. Reconstructive surgery was performed on 44 pairs of wounds (3 1 patients, age 33.9 +/- 17.5 years). Autograft survival was not altered by the substitute for reconstructive wounds, although a slight but significan t reduction (p = 0.015) was established in the burn category for substitute d compared with nonsubstituted wounds. However, the necessity for regraftin g was not increased by substitution. Cutometer measurements of reconstructi ve wounds with a dermal substitute demonstrated a significant increase of p liability (50 percent, p<0.001), elasticity (defined as immediate extension , 33 percent, p = 0.04), maximal extension (33 percent, p = 0.002), and imm ediate retraction (31 percent, p = 0.01), as compared with nonsubstituted w ounds. After burn surgery, no improvement was found for the different elast icity parameters. Dermal substitution in a one-stage grafting model seems f easible with respect to graft survival. Skin elasticity was considerably im proved by the collagen/elastin dermal substitute after reconstructive surge ry.