475 Acute and Reconstructive Burn Surgery with a Bilaminate Polyurethane Skin Substitute: A Case Series

• Published in: Journal of burn care & research 2019-03, Vol.40 (Supplement_1), p.S211-S212
• Main Authors: Sangji, N F, Levin, J M, Friedstat, J S, Goverman, J, Chang, K M, Schulz, J T
• Format: Article
• Language: English
• ISSN: 1559-047X; 1559-0488
• DOI: 10.1093/jbcr/irz013.369

Abstract Introduction Dermal replacement devices are useful in coverage of large burn patients with limited donor sites, burns with exposed tendons, and reconstructive procedures. Commonly used dermal substitutes are costly and vulnerable to infection. A polyurethane bilaminate device which is relatively microbial-resistant has recently become available. Here we review our initial experience using this device. Methods In late 2017 we began using BTM in reconstruction and recently extended use to acute burns. We identified representative patients (5 reconstructive and 1 acute) who were grafted with BTM, followed in 3 weeks by split thickness skin grafting (STSG) or in one case cultured epithelial autografting (CEA) and 6:1 meshed STSG. Charts were reviewed for wound bed infection defined as purulent destruction of bilaminate +/- surrounding erythema in adjacent skin, requiring debridement or the initiation of antibiotics. Results There were no wound infections in the patients and BTM was well incorporated and easily delaminated within 3 weeks in every case. Subsequent autograft take was excellent. All surgeons in our practice reported ease of use in the operating room. Figure 1 shows the stages in axillary reconstruction of Patient 1, who underwent release and graft of his right axilla with BTM followed by STSG. Autograft take was 100% and ROM normalized. Figure 2 shows the results of a in Patient 2, who had a 95% TBSA burn and underwent excision and BTM placement followed by CEA. Her wound bed incorporated the BTM as well as in the reconstructive patients creating a robust surface for application of STSG and CEA. Conclusions Ease of use and engraftment of this bilaminate polyurethane device is as good or better than other analogous devices. We intend to use it increasingly in coming years for in both acute and reconstructive surgery. Applicability of Research to Practice We recommend the use of BTM as a wound bed matrix for acute and reconstructive burn patients.