[Efficacy of artificial dermis in repairing small to medium-sized deep partial-thickness scalds in infants and young children]

Objective: To investigate the efficacy of artificial dermis in repairing small to medium-sized deep partial-thickness scalds in infants and young children. Methods: The study was a retrospective observational study. From June 2022 to October 2024, 149 infants and young children with small to medium-sized deep partial-thickness scalds meeting the inclusion criteria were admitted to the Children's Hospital of Chongqing Medical University (hereinafter referred to as our institution). There were 96 males and 53 females, aged from 2 days to 3 years. Based on wound management method, the children were divided into debridement-alone group (n=55), artificial dermis group (n=31), autologous split-thickness skin group (n=36), and combined skin grafting group (n=27). Wounds in the first group of children underwent debridement alone. Wounds in the latter three groups of children were treated with artificial dermis transplantation, autologous split-thickness skin grafts transplantation, or artificial dermis combined with autologous split-thickness skin grafts transplantation, respectively, following debridement. Donor sites for autologous split-thickness skin grafts were the head, back, or lateral thigh. After debridement, wound secretion specimens were collected from the debridement-alone group and artificial dermis group of children for microbial detection, the detection rate was calculated, and wound infection was observed. Wound healing time and length of hospital stay (referring to the length of hospital stay in the Department of Burn and Plastic Surgery of our institution, the same hereafter) were recorded in four groups of children. At the 6-month follow-up after wound healing, the scar (referring to primary wound site scars, the same hereafter) condition of four groups of children was assessed using the modified Vancouver scar scale (mVSS), and both total mVSS score and pliability score were recorded. The total mVSS score of scars was the primary outcome indicator; other indicators were secondary outcome. Results: After debridement, the microbial detection rate in wound secretion specimens of children in debridement-alone group was 29.1% (16/55), significantly higher than 9.7% (3/31) in artificial dermis group, χ²=4.34, P<0.05. Wound infection occurred in 2 children in debridement-alone group, whereas no wound infection occurred in children in artificial dermis group. Compared with that in debridement-alone group, the wound healing time of children in artificial dermis group, autologous split-thickness skin group, and combined skin grafting group was significantly shortened (P<0.05). Compared with that in artificial dermis group, the wound healing time of children in autologous split-thickness skin group was significantly shortened (P<0.05). Compared with that in autologous split-thickness skin group, the wound healing time of children in combined skin grafting group was significantly prolonged (P<0.05). Compared with that in debridement-alone group, the length of hospital stay of children in artificial dermis group and autologous split-thickness skin group was significantly shortened (P<0.05). Compared with that in artificial dermis group, the length of hospital stay of children in autologous split-thickness skin group was significantly shortened (P<0.05), the length of hospital stay of children in combined skin grafting group was significantly prolonged (P<0.05). Compared with that in autologous split-thickness skin group, the length of hospital stay of children in combined skin grafting group was significantly prolonged (P<0.05). At the 6-month follow-up after wound healing, the total mVSS score of scars of children in debridement-alone group was 8.1±1.1, significantly higher than 6.8±0.9 in artificial dermis group (with mean difference of 1.3, 95% confidence interval of 0.8 to 1.8, P<0.05), and significantly lower than 9.4±1.5 in autologous split-thickness skin group (with mean difference of -1.3, 95% confidence interval of -1.8 to -0.8, P<0.05). Compared with that in artificial dermis group, the total mVSS score of children in autologous split-thickness skin group was significantly increased (with mean difference of -2.6, 95% confidence interval of -3.2 to -2.0, P<0.05). Compared with that in autologous split-thickness skin group, the 7.7±1.0 of total mVSS score of children in combined skin grafting group was significantly decreased (with mean difference of 1.7, 95% confidence interval of 1.1 to 2.3, P<0.05). Compared with that in debridement-alone group, the scar pliability score of children in artificial dermis group was significantly decreased (P<0.05). Compared with that in artificial dermis group, the scar pliability score of children in autologous split-thickness skin group was significantly increased (P<0.05). Compared with that in autologous split-thickness skin group, the scar pliability score of children in combined skin grafting group was significantly decreased (P<0.05). Conclusions: Artificial dermis used for the repair of small to medium-sized deep partial-thickness scald wounds in infants and young children can improve scar quality, reduce the risk of wound infection, and relatively shorten wound healing time. It is particularly suitable for infants and young children whose aesthetic and functional outcomes are prioritized.