796 Use of a Synthetic Matrix Instead of Allograft for Temporizing a Major Burn

Abstract

Abstract Introduction Cryopreserved cadaveric skin allograft is often used in our burn center as a temporary covering after burn excision. While allograft affords many benefits for the burn wound, it also often fails to engraft, particularly in large burns, thus requiring a return to the operating room for exchange. We report here our experience with using a synthetic dermal matrix in two patients with large burns. Using a synthetic dermal matrix has allowed the safe management of a large burn with decreased need to return to the operating room for allograft exchange. Methods A retrospective chart review was undertaken of two patients, who presented sequentially to the burn unit. Both patients were male, in their 30s, and otherwise healthy. Each had sustained 55% TBSA burns; the lower extremities of both were deeply injured (deep partial- and full-thickness). In each patient, the left leg was treated with the institution’s standard of excision, allografting, allograft exchange, and then split-thickness skin grafting. The right leg after excision was placed at least partially in a synthetic dermal matrix with a smaller area of allografting as needed. The time from application of the dermal matrix to delamination and split-thickness skin grafting of the right leg was noted. Results In patient #1, the time from matrix application to delamination and STSG was 31 days. In patient #2, it was 26 days (see Table 1). Patient #1 had 4446cm2 of matrix applied, while 2268cm2 were used in patient #2. For both of these patients, the right leg was largely left undisturbed during this time, while the left leg underwent allograft exchange and split-thickness skin grafting. Had these patients’ right legs required allograft exchange once weekly, the use of allograft (which is provided in 232cm2 packages) would have been much higher. Patient #1 would have required roughly 20 units of allograft every week for 5 weeks (100 units total). Patient #2, with half the area and a slightly quicker time to grafting, would have required 40 units in total. A substantial cost savings in allograft was realized by use of this matrix and does not include the operating room costs saved. Conclusions Application of a synthetic dermal matrix to a well-excised burn wound can allow for decreased use of allograft in large burns, where allograft is traditionally applied and exchanged as a temporizing measure. This can result in a significant decrease in product use, the operative time spent exchanging these allografts, and the patient blood loss that inevitably accompanies allograft exchange. Applicability of Research to Practice Synthetic dermal matrix can be safely and effectively used for coverage of large burns, with significant cost savings compared to use of cadaveric skin.