Burn Wound &Skin Substitutes
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This document discusses burn wound and skin substitutes. It describes temporary skin substitutes and dressings that provide a moist environment, protect wounds from fluid loss and bacteria, and require limited dressing changes to reduce pain. Temporary substitutes include biological tissues like allografts, xenografts, and amnion, as well as synthetic hydrocolloids and hydrofibers. Allografts are the gold standard but will eventually reject, while xenografts provide temporary coverage but do not vascularize. The document also discusses dermal substitutes, including double-layer and single-layer options, that improve scar quality and skin suppleness by increasing dermal elasticity. Dermal substitutes also limit surgical procedures
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Factors affecting wound healing:
• Site of wound and Structure involved
• Mechanism : Incision / Crush / Crush avulsion
• Contamination : foreign body / bacteria
• Loss of tissue
• Local factors : Vascular insufficiency / Previous radiation / pressure
• Systemic factors: Malnutrition / Vitamin and mineral deficiencies /
Immunosupression / Smoking.
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Burn Wound &Skin Substitutes
- 1. Burn wound and skin substitutes Seyed hassan Tavousi. MD Fellowship of Burn surgery IRAN
- 2. Skin Substitutes • Permanent skin substitute • Temporary skin substitute
- 7. Temporary Skin Substitutes and Dressings • Wound dressings for partial-thickness wounds should: • Provide a moist environment (migration of cells is more difficult if when there is a dry scab on the wound) • Protect the wound from excessive fluid loss and bacterial invasion. • Require a limited number of dressing changes (pain reduction).
- 8. Temporary dressing classification: • The main indication for temporary skin substitutes is partial-thickness wounds, of which donor sites are a special category, but essentially are similar wounds. • 1. Biological tissues, such as allograft, xenograft, and amnion (keratinocyte sheets and cells) • 2. Synthetic materials such as hydro colloids and hydrofibers • 3.Biosynthetic (Integra.Biobrane.Matriderm)
- 9. Biological Temporary dressings: • Allograft • Xenografts • Amnion
- 10. Allografts: • Gold standard of temporary wound closures • Fresh(7days) or Cryopreserved or Glycerolized • Vascularization • After 4-6 weeks will reject • Anti rejection drugs • Sandwich panel technic • Bed wound test • TEN&St.J&TSS
- 11. Allograft
- 12. Allograft
- 14. Xenografts: • Temporary coverage of wounds • Porcine xenografts • As a scaffold for dermal regeneration efforts • Also used fresh, after brief refrigeration, after cryopreservation, or after glycerol preservation • Temporary coverage of clean wounds such as superficial partial-thickness burns and donor sites and has been used in patients with TEN.
- 15. Xenografts: • Combined with silver to supress wound colonization • Porcine xenograft does not vascularize, but it adheres to clean superficial wounds and can provide excellent pain control while the underlying wound heals.
- 17. Double Layers DS • 1-Integra(composed of bovine collagen and gly- cosaminiglycannes) • 2-Hyalomatrix • 3-Matriderm(composed of collagen mixed with elastin fibers)
- 20. Single layer DS • Matriderm(burn&reconstructive surgery) • Integra(without silicon layer) • Alloderm(derived from porcine dermis)(abdominal wall reconstruction or internal brass in mammary ptosis or after reduction.) • Glyaderm(Clinical indications include burns coverage and trauma.) • Gammagraft
- 24. Summary: • Dermal substitutes, used as temporary or permanent devices. • Improve the quality of scar and increase suppleness of the final cover- age by increasing elasticity of the dermal part of the skin. • Dermal substitutes looks better than using a simple skin graft, especially when applied over a bone structure. • Limiting the number of surgical procedures • Cost
Editor's Notes
- Deep Burn
- After Exicion
- Autograft
- Autograft