Skin replacement with a collagen based dermal substitute, autologous keratinocytes and fibroblasts in burn trauma

This case report describes the successful wound management of a 19-year-old patient with 76% of his body surface burnt. Due to the severity of the burns and the limited availability of native skin, 63% of the body surface were covered with Integra®, a dermis equivalent. This material has been developed for the reconstruction of dermal structures and is designed as a bilayer. It consists of a modified, bovine collagen matrix and a silastic membrane facing toward the body surface. After vascularization of Integra®, the epidermal skin replacement was created in a second step. In four different therapy procedures autologous, cultivated keratinocytes were combined with autologous fibroblast suspensions of various concentration and split-thickness skin as a 1:6 mesh graft. Rapid and largely complication-free wound healing could be achieved despite the limited availability of native skin. A correlation could be observed between the time of complete wound closure and the number of fibroblasts applied. The patient was monitored over a period of 1 year and showed good functional and cosmetic results.