Use of Dermal Substrate for the Treatment of Pediatric Deep Partial-Thickness Burns.

Abstract

Background: Dermal substrates (DS) are native skin substitutes applied to facilitate wound healing in burn patients, either as definite treatment or to prepare wound beds for grafting. Our study aimed to characterize wound healing after DS application among pediatric patients with deep partial-thickness burns.

Methods: We retrospectively reviewed patients <18 years old at our American Burn Association-verified pediatric burn center from 2015-2023 who underwent burn excision and application of either DS alone or DS with subsequent autografting. All patients were treated with a single DS containing fetal bovine dermal repair scaffold. We collected demographic data, injury details, operative procedures, and postoperative wound complications. We compared patients with χ² and Fisher exact tests.

Results: Among 205 patients, 84.4% healed with treatment with DS alone and 15.6% required autografting after DS application. Median age at DS application was 3.0 years. Most patients were male (60.0%) and White (63.9%). Patients most commonly had scald (47.8%) or flame burns (32.2%). Median total body surface area burned was 6.0% (IQR 3.0%, 10.3%). Patients needing autografting after DS placement healed a median of 50% (IQR 28.1%, 77.5%) of their original wound surface area after DS application. Complications were overall low in both groups. Patients who only required DS had lower rates of wound infection (2.9% vs 12.5%, P = .029) and scar contracture compared with those who required subsequent autografting (5.8% vs 15.6%, P = .045).

Conclusions: Children with deep partial-thickness burn injuries treated with DS alone had a high proportion of wound healing and low rates of complications. Although some patients may require subsequent autografting after DS application, the proportion of the wound requiring autografting was half of the size of the original wound. Our findings can help surgeons counsel pediatric burn patients and their families about expectations following DS application for deep partial-thickness burns.