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Published on: February 23, 2024
Use of Dermal Substrate for the Treatment of Pediatric Deep Partial-Thickness Burns
Katherine C Bergus1, Dana M Schwartz1, Kelli N Patterson1
1Nationwide Children's Hospital, Burn Center, 700 Children's Drive, Columbus, Ohio.
Insights
Dermal substrates (DS) promote healing in pediatric deep partial-thickness burns, with most patients healing without autografting. DS application resulted in fewer wound infections and scar contractures compared to autografting.
Area of Science:
- Regenerative Medicine
- Biomaterials Science
- Pediatric Surgery
Background:
- Dermal substrates (DS) are utilized as skin substitutes to aid wound healing in burn patients.
- They can serve as definitive treatment or prepare wound beds for subsequent grafting.
- This study focuses on characterizing wound healing outcomes after DS application in pediatric patients with deep partial-thickness burns.
Purpose of the Study:
- To evaluate the efficacy of dermal substrates (DS) in promoting wound healing for pediatric patients with deep partial-thickness burns.
- To compare complication rates between DS treatment alone versus DS with subsequent autografting.
Main Methods:
- Retrospective review of pediatric patients (<18 years) treated with DS (fetal bovine dermal repair scaffold) from 2015-2023.
- Data collected included demographics, burn details, surgical procedures, and postoperative complications.
- Statistical comparison using χ² and Fisher exact tests.
Main Results:
- Of 205 patients, 84.4% healed with DS alone; 15.6% required autografting.
- Patients treated with DS alone showed significantly lower rates of wound infection (2.9% vs 12.5%) and scar contracture (5.8% vs 15.6%) compared to those requiring autografting.
- For patients needing autografting, the grafted area represented a median of 50% of the original wound surface.
Conclusions:
- Dermal substrate treatment alone is highly effective for pediatric deep partial-thickness burns, achieving high healing rates with low complications.
- While some patients may need autografting, DS application is a viable strategy.
- Findings aid surgeons in counseling families regarding outcomes of DS application for pediatric burns.
Background:
Dermal substrates (DS) are native skin substitutes applied to facilitate wound healing in burn patients, either as definite treatment or to prepare wound beds for grafting. Our study aimed to characterize wound healing after DS application among pediatric patients with deep partial-thickness burns.
Methods:
We retrospectively reviewed patients <18 years old at our American Burn Association-verified pediatric burn center from 2015-2023 who underwent burn excision and application of either DS alone or DS with subsequent autografting. All patients were treated with a single DS containing fetal bovine dermal repair scaffold. We collected demographic data, injury details, operative procedures, and postoperative wound complications. We compared patients with χ2 and Fisher exact tests.
Results:
Among 205 patients, 84.4% healed with treatment with DS alone and 15.6% required autografting after DS application. Median age at DS application was 3.0 years. Most patients were male (60.0%) and White (63.9%). Patients most commonly had scald (47.8%) or flame burns (32.2%). Median total body surface area burned was 6.0% (IQR 3.0%, 10.3%). Patients needing autografting after DS placement healed a median of 50% (IQR 28.1%, 77.5%) of their original wound surface area after DS application. Complications were overall low in both groups. Patients who only required DS had lower rates of wound infection (2.9% vs 12.5%, P = .029) and scar contracture compared with those who required subsequent autografting (5.8% vs 15.6%, P = .045).
Conclusions:
Children with deep partial-thickness burn injuries treated with DS alone had a high proportion of wound healing and low rates of complications. Although some patients may require subsequent autografting after DS application, the proportion of the wound requiring autografting was half of the size of the original wound. Our findings can help surgeons counsel pediatric burn patients and their families about expectations following DS application for deep partial-thickness burns.
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