Acellular allogenic dermis does not hinder initial engraftment in burn wound resurfacing and reconstruction

Donor site morbidity, including pain and potential hypertrophic scarring, increases directly as donor site thickness increases. Autograft hypertrophy increases inversely to the thickness of autograft harvest. Both of these liabilities might be lessened by the ready availability of a functioning, "off-the-shelf" dermal substitute. The most immunogenic components of transplanted allograft skin are the cellular elements of the epidermis and dermis. If these components are removed, the remaining noncellular dermal tissue is relatively immunologically inert. We grafted 10 sites with matched control areas in six patients, with limited (< 25%) areas of the body surface appropriate for donor harvest, who required either acute resurfacing or a reconstructive procedure requiring split-thickness autografting. The six children (three girls and three boys) had an average age of 5.2 +/- 0.9 years (range, 2.8 to 10), and an average burn size of 68.7% +/- 6.7% (range, 47% to 85%). The 10 study and control sites were all parts of 10 separate procedures in these massively burned children, nine sites being reconstructive releases, and one excised acute burn. Successful epithelialization was noted at 7 days over 83% +/- 3.4% (range, 60% to 95%) at the cryopreserved acellular human dermis sites and 83.3% +/- 4.3% (range, 60% to 98%) at the control sites (NS, p = 0.96). Duration of follow-up has been 11.9 +/- 3.5 weeks (range, 2 to 29), with no difference in results by Vancouver Scar Scores. We conclude that cryopreserved acellular human dermis will engraft successfully and support engraftment of overlying thin autograft. Initial results relating to the effectiveness of cryopreserved acellular human dermis in optimizing appearance and function are encouraging, but longer follow-up is required before definitive conclusions can be made.