Biobrane: A Versatile Tool in the Armamentarium of the Reconstructive and Burns Surgeon

Abstract

Sir: Biobrane is becoming increasingly popular in the management of superficial and moderate-depth partial-thickness burns. When used appropriately, it has been shown to reduce pain levels, healing time, inpatient stay, and nursing requirements when compared with traditional dressings. We would like to draw the attention of the reconstructive community to the versatility of Biobrane above and beyond these well-known indications. Biobrane is a biosynthetic wound dressing first developed by Woodruff in 1979. It has many of the “ideal” properties highlighted by Pruitt and Levine in 1984.1 There is a great deal of literature available outlining the successful use of Biobrane in the management of partial-thickness burns in pediatric patients. There is also evidence for its use in the treatment of partial- and full-thickness burns in the adult, particularly in large burns and those involving joints and the hand. Various application modifications have been published to overcome coverage of difficult areas (e.g., use of the Biobrane glove to dress the foot and the Biobrane “jacket” to dress the torso). In addition to covering the burn wound, it is also used in the management of split-thickness skin graft donor sites, in both burned and nonburned patients. Its use in stenting split-thickness skin grafts has also been advocated. The use of Biobrane has been reported to cover the axillary defect following surgical excision for hidradenitis suppurativa.2 This single-stage procedure, with no donor-site morbidity, exhibited the ability to use Biobrane in colonized tissues. The limitations included a longer healing time and increased cost of dressing. Biobrane has also been used successfully after laser resurfacing of the face.3 It was well tolerated, minimized pain and drainage, decreased erythema, reduced healing time, and simplified nursing care. Similarly, Biobrane has been used as a dressing after mechanical dermabrasion. This study showed that Biobrane reduced erythema and healing time by up to 50 percent when compared with air-exposed wounds. The use of Biobrane has been reported in the successful treatment of serious skin conditions, such as toxic epidermal necrolysis4 and paraneoplastic pemphigus. Biobrane was applied to the extensive areas of erosion to assist in pain management and to provide a temporary barrier function. The treatment of serious skin conditions such as toxic epidermal necrolysis and pemphigus with Biobrane is an area that warrants further evaluation, as it may contribute to the overall treatment and comfort of these patients. Chronic wounds such as large venous ulcers have also been managed successfully using Biobrane. There are several case reports concerning the use of Biobrane in the contemporary literature. The skin substitute was used in the treatment of a life-threatening esophageal fistula by covering an expandable metallic stent and in the management of subcutaneous colostomy perforation. Biobrane has also been used in the successful management of sternotomy wounds that were not closed immediately due to massive intraoperative edema formation. Adverse affects following the use of Biobrane are uncommon, but surgeons should be aware of the possibility of contact dermatitis, hypersensitivity, and hypertrophic scarring.5 We believe that Biobrane is a highly versatile tool that should be in the armamentarium of all reconstructive and burns surgeons. Further randomized controlled trials assessing its use in a variety of conditions are warranted. Iain S. Whitaker, M.R.C.S. The Welsh Plastic Surgery and Burns Unit The Morriston Hospital Swansea, United Kingdom Paul Mallinson, M.B.Ch.B. Pinderfield's Hospital Wakefield, United Kingdom Peter J. Drew, F.R.C.S.(Edin.), F.R.C.S.(Eng.), F.R.C.S.Plast. Department of Burns and Plastic Surgery The Welsh National Plastic Surgery and Burns Unit The Morriston Hospital Swansea, United Kingdom DISCLOSURE None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this communication.