Austin Ryan E, Merchant Nishant, Shahrokhi Shahriar, Jeschke Marc G
Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Toronto, 149 College St, Stewart Building, 5th Floor, Toronto, ON M5T 1P5, Canada; Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, D704, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, University of Toronto, D704, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada.
Burns. 2015 Jun;41(4):749-53. doi: 10.1016/j.burns.2014.10.003. Epub 2014 Nov 15.
In many circumstances early burn excision and autografting is unsafe or even impossible. In these situations, skin substitute dressings can be utilized for temporary wound coverage. Two commonly used dressings for this purpose are cadaveric allograft and Biobrane™.
Five year retrospective cohort study evaluating upper extremity burns treated with temporary wound coverage (Biobrane™ or allograft). The primary outcome was to determine the impact choice of wound coverage had on operative time and cost. The secondary outcome was the need for revision of upper extremity debridement prior to definitive autografting.
45 patients were included in this study: 15 treated with cadaveric allograft and 30 treated with Biobrane™ skin substitute. Biobrane™ had a significantly lower procedure time (21.12 vs. 54.78 min per %TBSA excised, p=0.02) and cost (1.30 vs. 2.35 dollars per minute per %TBSA excised, p=0.002). Both techniques resulted in 2 revisions due to complications.
Biobrane™ is superior to cadaveric allograft as a temporizing skin substitute in the acute burn wound, both in terms of procedure time and associated cost. We believe that this is largely due to the relative ease of application of Biobrane™. Furthermore, given its unique characteristics, Biobrane™ may serve as a triage and transport option for severe burns in the military and mass casualty settings.
在许多情况下，早期烧伤切除和自体植皮是不安全的，甚至是不可能的。在这些情况下，可以使用皮肤替代敷料进行伤口的临时覆盖。用于此目的的两种常用敷料是尸体同种异体皮和生物膜（Biobrane™）。
一项为期五年的回顾性队列研究，评估采用临时伤口覆盖（生物膜或同种异体皮）治疗的上肢烧伤。主要结果是确定伤口覆盖方式的选择对手术时间和成本的影响。次要结果是在进行确定性自体植皮之前上肢清创术的修正需求。
本研究纳入45例患者：15例采用尸体同种异体皮治疗，30例采用生物膜皮肤替代物治疗。生物膜的手术时间显著更短（每切除1%体表面积分别为21.12分钟和54.78分钟，p = 0.02），成本也更低（每切除1%体表面积每分钟分别为1.30美元和2.35美元，p = 0.002）。两种技术均因并发症导致2次修正。
在急性烧伤创面中，作为临时皮肤替代物，生物膜在手术时间和相关成本方面均优于尸体同种异体皮。我们认为这在很大程度上是由于生物膜的应用相对简便。此外，鉴于其独特特性，生物膜可作为军事和大规模伤亡情况下严重烧伤的分诊和转运选择。
