Efficacy of dermal substitute on deep dermal to full thickness burn injury: a systematic review

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The principal management of deep dermal to full thickness burns is early excision and immediate wound closure, and the gold standard is split thickness skin graft (STSG).1 Mortality is significantly reduced with early excision especially in patients without inhalation injury.1 However, providing immediate wound coverage or closure in major burn injuries with total burn surface area (TBSA) >25% can be challenging as donor site is scarce. The ideal skin substitute is based on the principles of ‘like replacing like’, an anatomical and functional replacement of native skin, which is readily accessible and easy to apply.3 In the hopes of achieving this, dermal substitute was developed by Yannas and Burke in the 1980s with the aim of providing wound coverage that is integrated into the wound bed permanently while facilitating wound healing and hypothesizing that the healed ‘neo‐dermis’ would anatomically function more like dermis rather than scar.3 Dermal regeneration templates (DRTs) have a porous dermal matrix with a silicone epidermal layer which is applied on viable wound bed. Once DRT achieved vascularization, a thin STSG is applied to obtain definitive closure. This can be performed as a two‐staged or single staged procedure.
Due to an increase development of bioengineered skin substitute, there are several studies reporting the effectiveness of bioengineered skin on the management of burn injuries.6 A systematic report performed by the Australian Safety and Efficacy Register of New Interventional Procedures (ASERNIP) investigated all available types of biosynthetic substitute; however, due to the diversity of skin substitute there were too much heterogeneity in the studies to draw any significant conclusions.10
To overcome this issue, the aim of the review was to maintain a narrow scope of focus; directed only on dermal substitute rather than various bioengineered skin substitutes in order to pool homogenous and relevant outcomes. The focus on dermal substitute was because it has several unique properties: (i) it is able to provide immediate coverage on the burn wound post‐excision and established a physiological barrier against fluid loss and microorganism colonization; (ii) it provides a scaffolding which promotes the formation of a neo‐dermis that is permanently integrated without being rejected; and (iii) it also permits the use of thin STSG to decrease donor site morbidity and allows quicker healing for re‐crop if required. The objective is to systematically review the efficacy of DRTs on acute deep dermal to full thickness burns post‐excision.
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