Time to give Deep Burn Patients some Skin, albeit Artificial

Biodegradable Dermal Regeneration Template (DRT) makes for skin loss in deep burn

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New Delhi: Healing and prevention of complications in deep burn patients has become easier, thanks to ‘Integra’, a biodegradable artificial skin.

Talking to Medicare News, Dr Anup Dhir, Cosmetic Plastic Surgeon and Andrologist and Senior Consultant at Apollo Hospital, said, ‘Deep burns need treatment by early excision & skin grafting. However, if the area is big, then enough skin grafts may not be available immediately. In these situations, artificial skin like integra helps in initial healing & preventing complications.

Dr Dhir, Past President, Indian Association of Aesthetic Plastic Surgeons, further said, ‘Burns cause skin loss and post burn reconstruction needs quick replacement of the damaged skin so that the recovery can be hastened. The complete regeneration of adult skin has not been achieved experimentally so far but partial regeneration can be done using a biologically active scaffold called dermal regeneration template (DRT), these sponge-like scaffolds are usually made from animal collagen and  with a thin silicon sheet on top and thus are biodegradable during the regenerative process.’

‘The use of DRTs in the treatment of skin loss requires a two-step procedure. That is, after a wound is surgically excised  and prepared, a DRT is grafted into the area of skin loss (first step). When Template is placed on a wound where burned or scarred skin has been removed, it  provides the needed framework for the blood vessels and dermal skin cells to re-grow into a new dermal skin layer. 2-3 weeks the outer silicon layer comes off and a split-thickness (autologous) skin graft is gently placed over the new tissue to provide wound coverage (second step.),’ added Dr Dhir.

The Integra is a two-layer skin regeneration system. The outer layer is made of a thin silicone film that acts as the skin’s epidermis. It protects the wound from infection and controls both heat and moisture loss. The inner layer is constructed of a complex matrix  derived from bovine collagen. This porous material acts as a layer for regenerating dermal skin cells, which enables the re-growth of a functional dermal layer of skin. Once dermal skin has regenerated, the silicone outer layer is removed and replaced with a thin epidermal skin graft. Integra was the first skin substitute to be FDA-approved, and is approved for use in full- and partial-thickness burn wounds.

If the burn wound is allowed to heal without intervention then the skin heals with contraction thus forming contractures which can lead to serious deformity and disability if overlying joint or other vital areas of the body besides being cosmetically very demoralising for the patient. Here also this artificial skin is useful for cosmetic reconstruction.

Majority of the burns are preventable with good safety precautions and education. They often occur at home, involving women and children. In villages, cooking on stoves or fires is a major hazard. Fire safety should be part of every home, public place or industry and children should be taught how to keep themselves safe from these dangers.

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