1. Clinical Experience with Biological and Biosynthetic Skin Substitutes: A Survey of United Kingdom and Australasian Burns Units
JCR Wormald1 JA Dunne1 A Murray2 JM Rawlins3
1 Plastic Surgery Department, Chelsea and Westminster Hospital, UK
2 Plastic Surgery Department, Stoke Mandeville Hospital, UK
3 Plastic Surgery and Burns Department, State Adult Burn Unit, Fiona Stanley Hospital, Perth WA, Australia
23 BBA (different site paeds and adults) – otherwise 17
12 ANZBA (16 on Bi-NBR?!?) – otherwise 8
1-5 cases
6-10 cases
11-15 cases
16-20 cases
21+ cases
Cultured epithelial autografts 4 -
Cultured skin substitutes 1
ReCell 2
Cadaveric skin 3
Porcine xenograft
Suprathel
Biobrane 8
Pelnac
Matriderm
Two-stage Integra
Introduction
A decade ago burns units in the United Kingdom (UK) were in the early stages of adopting skin substitutes, and there has been a considerable increase in the range available to the burns surgeon since. However, widespread clinical experience with skin substitutes is unknown, and restricted to those units publishing outcomes. The UK and Australasia have universal health care systems, providing free care at the point of access. This survey was undertaken to determine current clinical experience of skin substitutes and factors determining their use in two continents.
Methods
A structured survey was sent via to 25 regional burns units in the United Kingdom, Australia and New Zealand (hosted by SurveyMonkey). The survey asked respondents to determine the number of cases performed per year for a range of skin substitutes. Biological, biosynthetic and synthetic materials were included as skin substitutes. Reasons for deciding to use skin substitutes were established and barriers to use surveyed.
Table 2. Number of paediatric cases performed per year by burns units
Results
Responses were received from 14 of 25 regional burns units (56%) with all units using skin substitutes. UK burn units used a mean of 5 types of skin substitutes (range 1 to 8) compared to 4 in Australasia (range 3 to 6). Life-threatening burns, donor site availability, total burn area and depth were cited as indications by more than 75% of respondents. Lack of federal approval was cited as a restriction to use in Australasia (e.g. Matriderm) and cost limited use in 36% of all respondents.
Fig. 1. Commonest factors in decision to use skin substitutes
1-5 cases
6-10 cases
11-15 cases
16-20 cases
21+ cases
Cultured epithelial autografts 2 - 1
Cultured skin substitutes
ReCell
Cadaveric skin 3
Porcine xenograft
Suprathel
Biobrane 5
Pelnac
Matriderm
One-stage Integra
Two-stage Integra
Conclusions
Skin substitute use in UK and Australasian burns units supplements traditional methods of wound cover, in particular for large or complex injuries. Similar skin substitutes are used in both regions, however Australasian respondents cited absence of federal approval as restricting use, in particular with Matriderm. This study demonstrates the increased clinical experience with skin substitutes in burn care over the past decade, however there are few comparative studies. The development of the bi-national burns registry in Australasia is leading to systematic collection of quality of care and outcome data in burns. Increased collaboration between units can improve the evidence base for skin substitute use in burns.
Table 1. Number of adult cases performed per year by burns units
Mr. Justin CR Wormald MBBS(hons) MRes(hons) MRCS
Core Surgical Trainee (CT1)
Chelsea and Westminster Hospital NHS Foundation Trust
London