[The role of skin substitutes in the surgical treatment of extensive burns covering more than 60 % of total body surface area. A review of patients over a 10-year period at the Tours University Hospital.]
Service de chirurgie plastique reconstructrice et esthétique, centre des brûlés, hôpital Trousseau, CHRU de Tours, 37044 Tours cedex 9, France. Annales de chirurgie plastique et esthetique
(Impact Factor: 0.31).
10/2013; 60(2). DOI: 10.1016/j.anplas.2013.09.002
Progress in intensive care and surgery has made it possible to significantly improve the survival of victims with burns over 60% of total body surface area (TBSA). Coverage of the excised areas of these patients can be difficult when there is a shortage of skin donor sites; then the role of skin substitutes can be important.
This retrospective study included patients with burns covering more than 60% TBSA and treated at the Tours University Hospital over a period of 10 years. Patients who died during the first week or who presented superficial burns were excluded. The various substitutions means to temporarily or permanently replace the cutaneous barrier are presented. The biological dressings associated with grafts expanded by six according to the sandwich technique, allografts and xenografts, widely expanded postage stamp skin grafts using a modified Meek technique (Humeca(®)), temporary cutaneous substitutes such as Biobrane(®) and skin substitutes colonized by autologous cells (Integra(®)) are presented.
Forty-four patients were admitted. Self-immolations represented 52% of the cases. Twenty-one patients were treated with Integra(®), 5 with Biobrane(®), 17 with sandwich grafts and 4 with postage stamp skin grafts. Integra(®) was widely used when donor sites were insufficient. The mean number of surgical procedures per patient was 8.4. The mean duration of hospitalization was 155 days. Twenty-four patients survived until the end of treatment. Eighteen patients died during the first week before any surgery could be performed. Two patients died at the end of treatment. The overall survival rate was 55%. It was 92% for patients who survived the first week. The principal sequel were functional (hand, cervical, thoracic and axillary contractures) and aesthetic (face and hands). Associated treatments were pressotherapy, physical therapy, ergotherapy and thermal water therapy.
By temporarily replacing the cutaneous barrier in the absence of sufficient donor sites, skin substitutes make it possible to increase the survival of patients with very extensive burns and to optimize their treatment.
Available from: Paola Monari
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ABSTRACT: Non melanoma skin cancers (NMSC) are the most common human neoplasms,encompassing basal cell carcinoma (BCC) and squamous cell carcinoma(SCC), butalso cutaneous lymphomas, adnexal tumors, merckel cell carcinoma and other rare tumors. The incidence of BCC and SCC varies significantly among different populations, and the overall incidence of both tumors has increased over the last decades. Although generally associated with a favorable prognosis, recent evidence suggests that the mortality rates of SCC might have been underestimated up-to-date1.According to Medicare data,NMSC is the fifth most expensive cancer for health care systems. This increased economic burden is not associated withthe cost of treating an individual patient, but with the large number of affected patients and the recurrence rates2. Therefore, the adequate management of the primary tumor with a complete excision becomes a priority not only for the patient but also for the public health systems. Multiple treatment modalities are currently usedin clinicalpractice for the treatment of NMSC. While surgical excision (SE) remains the gold standard of care, non-surgical techniques have gained appreciationdue to lower morbidity and better cosmetic results. The optimal management of treatment includes a completetumor clearance, preservation of the normal tissue function, and the best possiblecosmetic outcome3. Surgery with a predefined excision margin is the treatment of choice for most NMSCs, with Mohs micrographic surgery being recommended for tumorsconsidered to be at a higher recurrence risk or those developing oncosmetically sensitive areas4-5. Therefore, the surgical approach of aNMSC consists threedifferent and equally important steps. First the pre-operative clinical assessment of the tumormargins, which can be facilitated by the use of dermoscopy.Second, the definition of the surgical marginsdepending on the tumor subtype and its biological behaviourFinally,the surgical proceduremust be designedbased on the anatomicsiteand the patient's charachteristics. This preoperative assessment requires specific skills and might be performed by one physician, the dermoatosurgeon, two collaborating specialists, namely a dermatologist and a surgeon.
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