A dermal substrate made of collagen--GAG--chitosan for deep burn coverage: first clinical uses

In cases of severe burns, it seems necessary to excise burnt tissues as soon as possible and to cover the excised area immediately with a skin substitute, when few autografts are available. We report here the first clinical uses of a dermal substrate made of collagen--GAG--chitosan grafted immediately after early excision, then epidermalized either with autologous meshed autograft or with autologous cultured epidermis. The dermal substrate replaces the excised dermis by adhering to the underlying tissue, promoting fibrovascular ingrowth. Then after 15 days it can be epidermalized. The quality of the underlying dermis obtained permitted 100% take after epidermalization with large-meshed autograft, and tended to avoid the usual typical diamond aspect of the meshed skin. After epidermalization with autologous cultured autograft, the quality of the underlying dermis permits a good take. The best aspect is obtained by combining dermal substrate and autologous cultured epidermis. Even if it still does not replace the high quality of a homograft, this dermal substrate is a promising solution for replacement of dermis. It is always available, can be stored and is exempt from micro-organism transmission.