Clinical Evaluation of Glyaderm, a Dermal Substitute Based on Glycerinized Donor Skin

The main goal in burn management has always been increasing the survival of severely burned patients by rapid debridement and early closure of burn wounds, consequently reducing the risk of infection, sepsis and multi-organ failure. However, in the last decennia, surgical emphasis has shifted from survival to ‘quality of survival’, especially by improving the residual scars and preventing secondary contractures. Research and development of dermal skin substitutes has been directed towards improvement of scar quality by a bilayered reconstruction of dermis and epidermis. Allogeneic skin recovered from deceased donors is often used in the management of burns and other full thickness skin defects as a temporary coverage before definitive closure with autologous skin. Donor skin is used to improve the quality of the wound bed before grafting with autologous skin, as a biological dressing for partial thickness wounds (Hermans, 1989), or as overlay on widely expanded autograft (sandwich technique, Kreis et al., 1989). Excised full thickness defects treated with thin and widely expanded split thickness autografts often heal with an un-aesthetic, hypertrophic scar as final result as shown in figure 1. In patients with extensive burns it is not possible to use thicker autografts with limited expansion because of increased donor site morbidity. These results may improve if a dermal subsitute is placed underneath the split thickness skin graft. This substitute can replace the dermal tissue that is lost and provide a scaffold to the cells infiltrating in the wound bed during the healing process. The scaffold must be designed in such a way the cells will produce the new collagen fibers in a random organized structure, replacing slowly the scaffold material instead of making the typical parallel oriented fibers of scars (Van der Veen et al., 2010). In the past decades, several dermal substitutes products have become available but the clinical evidence on the effectiveness is limited until now (Brusselaers et al., 2010). These commercially available products are based on animal derived collagen or human skin and associated with high costs (Jones et al., 2002).