1Burn Center H.I.A. Sainte Anne Toulon FRANCE
Introduction : Flaps are the gold standard to cover exposed tendons, bones or neuro-vascular pedicles . In difficult situations, as deep and large wound defects, flaps are difficult to realize. Artificial dermis (AD) could be used as an alternative solution.
Material and method : After excision of death and infected tissue, large and deep defects with exposed vessels, nerves, tendons or bones, have been covered by a tridimentional collagen elastin matrix and an epidermal graft . NWPT have been used for deep and infected wound defects. Follow up was clinical and functional assessment.
Results : 39 patients (23to 72 YO) 25 males ,14 females, were treated. 20 for burn,19 for necrotizing fasciitis. 12 hands, 25 lower legs and feet and 5 others locations were grafted. Surfaces grafted were 74 cm2 to 1280 cm2 .NWPT was used for 18 patients, and changed every 4 days before grafting AD. Mean time before grafting AD after NWPT was 3 weeks.Mean healing time of the AD was 2 weeks . All exposed zones were covered. By restoring the shearing planes, collagen-elastin matrix thus avoid deep-rotted adhesion and improves the tegumentary suppleness and the final functional by the free tendinous play obtained under the composite grafts. With a final healing time and number of surgical procedures reduced. The good results were obtained with a simple surgical reproducible technic, without disadvantages of difficulties, potential complications, and donor site scaring of flaps. The graft incopore more naturally than a flap and ie allowed to wear normal shoes.
Conclusion:Even in difficult situation,AD could be considered as a surgical alternative to flaps,and could be used without any loose of chance, as the solution of first intention with keeping the possibility to use flaps in second recourse.
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