Artificial Dermis (AD), an alternative to flaps

Eric Dantzer1

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.


Bio to come

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