The effectiveness of AlloDerm in Massive Burns

J Korean Wound Management Soc > Volume 2(2); 2006 > Article

Original

Journal of the Korean Wound Management Society 2006;2(2): 87-92.

광범위화상에서 인체유래 무세포성 진피대체물(AlloDerm)의 임상적 유용성

전욱

한림대학교 의과대학 한강성심병원 외과학교실

The effectiveness of AlloDerm in Massive Burns

Wook Chun, M.D., Ph.D.

Department of Surgery, Burn Center, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea

Published online: 30 November 2006.

ABSTRACT

Many types of dermal substitutes are available which can help to reduce scar contracture and to improve aesthetical results when performing split thickness skin graft. Furthermore, we had to use wide meshed skin graft in treating massively burned patients due to limiting donor skin. Burn scar contracture has often causes a major problem especially in joint areas. Commonly used dermal substitutes with xeno-collagen have always required two separate surgical procedures and it is also somewhat vulnerable to infection in major burns. Especially burn centers without individualized burn ICU like Korea have prevented to use it widely due to relatively high infection rate. So we have tried the acellular dermal substitute (AlloDerm) in acute stage in massive burns. After removing feasible granulation tissues, AlloDerm was simultaneously grafted with skin graft. AlloDerms were always fixed together with the skin graft by small staples. Usually sheet, 1：1.5, 1：2 or 1：3 meshed autografts were applied on AlloDerm. While using 1：3∼5 meshed graft, cultured epithelial autografts were always overlayed on AlloDerm with 1：3∼5 meshed autograft. Forty-two patients were included in this investigation from March 2005 to August 2006. The average burn area was 36.5 (10∼80)% total body surface area (TBSA). The average number of operation was 2.86 (1∼5) times including escharectomy and skin grafts. The average length of days from admission to final skin graft was 36.3 (18∼63) days. AlloDerms were mainly applied on joint areas. Neither extra-operation time to graft nor additional preparation for wound bed required. The best results were showed with sheet skin graft on AlloDerm than meshed skin graft. The AlloDerm take rate was over 95%. A few problems developed on areas like popliteal and ankle regions. All of them were treated well by Betadine ointment dressing. No scar contracture occurred so far. AlloDerm can be used with skin graft as single stage operation. Furthermore it is strong against to infection due to relatively quick vascularization. Thus Alloderm can be useful on contaminated wounds in massive burn patients. The procedure using Alloderm found to be very simple, easy and effective in treating massively burned patients. (J Korean Wound Care Soc 2006;2:87-92)

Key Words: AlloDerm, Massive burns