Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns

Scarring and contracture are major long-term sequelae of meshed split-thickness autografting for full-thickness skin injury. In the absence of dermis, mature fibroblasts secrete collagen in the altered pattern of scar. This case report illustrates the use of an acellular dermal matrix processed from human allograft skin (AlloDerm) in the treatment of a full-thickness burn injury. The processing technique results in an acellular dermal matrix with normal collagen bundling and organization and an intact basement membrane complex. In these patients, AlloDerm exhibited a high percentage 'take' and supported an overlying meshed split-thickness skin autograft, applied simultaneously. The clinical observations of 'take' were confirmed with histological and electron-microscopic evaluation of biopsies which demonstrated host cell infiltration and neovascularization of the AlloDerm. No specific immune response was detected, either by histology or by lymphocyte proliferation assay. By providing a dermal replacement, the grafted dermal matrix permitted the use of a thin, widely meshed autograft from the donor site, without the undesirable scarring and contracture at the wound site that commonly results from this technique. If effective, this approach would markedly reduce the amount of donor skin required for split-thickness autografts in full-thickness burn injuries.