343 Versatility of a Synthetic Polyurethane Dermal Substitute

Abstract Introduction Dermal substitutes play an important role in burn care, utilized to temporize wound beds considered inadequate for autograft or when there are inadequate donor sites available. Innovations have aimed not only to provide a functional barrier and enhance tissue growth but to form a “neodermis”. The goal is to improve functional and cosmetic outcomes. The existing dermal substitutes differ in source (e.g., allograft, xenograft, synthetic, biosynthetic) and composition (proteins, cells, epidermal components). As burn surgeons look for the ideal construct, each of these multiple dermal substitutes in clinical practice has its advantages, disadvantages, and limitations. We describe our initial experience with a synthetic polyurethane dermal substitute in several clinical applications. Methods The product was introduced on a trial bases for five cases over 1 month. Case 1: 36-year old gentleman with 54% TBSA burns with early scar contractures of his neck prior to excision and grafting of all his full thickness wounds (250 cm2). Case 2: 51-year old gentleman with 67% TBSA burns (4000cm2 on bilateral thighs, left Achilles tendon). Case 3: 26-year old gentleman with a complex left thigh wound due to a Morel-Lavellee lesion after a motorcycle collision (950cm2). Case 4: 38-year old transgender woman with complex wounds of bilateral buttocks and hips s/p excisional debridement for acute on chronic skin and soft tissue infection of fibrotic tissue after silicone injections twenty years prior (1250cm2). Case 5: 61-year old gentleman who sustained 60% TBSA burns (8700cm2 on anterior/posterior trunk, buttocks, legs). In Cases 3 & 4 we applied Negative Pressure Wound Therapy on the product. Results The majority (4/5) were autografted at two or four weeks after single application. Time to grafting was influenced by time to maturation and availability of donor site. The incorporated within the entire wound bed. Subsequent autografting yielded excellent graft take except Case 1, where wound complications were not related to the use of. Case 5 remains ungrafted only due to paucity of donor site. Conclusions Our early experience with has demonstrated efficacy in a variety of clinical indications. Advantages in comparison to other dermal substitutes we have utilized include ease of application and post-operative care, robust incorporation, resistance to infection, and cost. Additional experience and rigorous clinical trials are needed to corroborate these f