The Role of Alternative Wound Substitutes in Major Burn Wounds and Burn Scar Resurfacing

Introduction

Early excision of major burns has been shown to improve patient outcomes. The lack of available donor sites from which to harvest conventional autologous skin grafts to achieve wound closure is challenging. Burke and Yannas in the early 1960s pioneered the introduction of alternative wound cover after burn excision. They invented a dermal scaffold composed of bovine collagen and shark glycosaminoglycan matrix with an epithelial equivalent, the silicon layer. This became known as Integra. During that same period, Rheinwald and Green, in 1975, described the technique of cultured epidermal autografts (CEA), which provided another alternative to help achieve wound cover. The first multicenter clinical trial using Integra was published in 1988. Integra was eventually granted approval by the U.S. Food and Drug Administration (FDA) in 1996 for use in acute burns.

Alternative wound substitutes provide biological wound cover either on a temporary or permanent basis. Permanent substitutes are mostly in the form of scaffolds that become integrated into the wound and eventually are replaced by host cells, with the scaffold itself finally undergoing reabsorption. Temporary substitutes, on the other hand, do not integrate into the wound; they temporarily adhere to the wound bed and may induce growth and promote healing of the underlying wound.