Current possibilities of using materials for temporary closure of burn wound surface

Authors

DOI:

https://doi.org/10.15574/PS.2022.76.92

Keywords:

burns, biological dressings, differentiation, alloskin, porcine xenograft

Abstract

The aim of the work was a comparative analysis of clinical effectiveness of existing materials for temporary closure of burn wounds.

The advantages of biological wound dressings over gauze or synthetic materials are obvious today. However, the issue of comparing the clinical effectiveness of allo- and xenografts remains debatable. The latter provide rapid reepithelialization, analgesia, wound protection and, as a rule, a favorable treatment outcome. In terms of personal experience, over the past 20 years, with the transition to active surgical tactics for the treatment of patients with burns, enough evidence has been accumulated to confirm the high efficiency of using xenodermografts from domestic pigs to close postoperative wounds. Regarding the advantages of animal derived materials, we can highlight the safety, affordable price, unlimited raw materials for their manufacture, as well as the avoidance of various moral, ethical and legal restrictions.

Thus, closure of burn wounds is a major issue in the treatment of thermal injuries, which is especially critical for deep and extensive burns.. Xenoderm grafts of our own design, which are widely used in clinical practice and significantly improve the course of burn disease are among the existing and most effective dressings in Ukraine.

No conflict of interests was declared by the authors.

Author Biography

V. Nagaichuk, National Pirogov Memorial Medical University, Vinnytsya

Municipal Non-profit Enterprise «Vinnytsia Regional Clinical Hospital Vinnytsia Regional Council», Ukraine

References

Aronoff M, Fleishman P, Simon DL. (1976). Experience in the application of porcine xenografts to split-graft donor sites. The Journal of trauma. 16 (4): 280-283. https://doi.org/10.1097/00005373-197604000-00005; PMid:772228

Artz CP, Rittenbury MS, Yarbrough DR. (1972). An appraisal of allografts and xenografts as biological dressings for wounds and burns. Annals of surgery. 175 (6): 934-938. https://doi.org/10.1097/00000658-197206010-00013; PMid:4555244 PMCid:PMC1355340

Becker D. (1981). Temporary dressing of burn wounds using sterile frozen porcine skin (author's transl). Unfallheilkunde. 84 (4): 158-160. [Becker D. (1981). Erfahungen mit passagerer Deckung von Verbrennungswunden mit frischer-steriler-gefrorener Schweinehaut. Unfallheilkunde. 84 (4): 158-160].

Boneva RS, Folks TM. (2004). Xenotransplantation and risks of zoonotic infections. Annals of medicine. 36 (7): 504-517. https://doi.org/10.1080/07853890410018826; PMid:15513301

Bromberg BE. (1970). Burn wound management with biologic dressings. New York state journal of medicine. 70 (12): 1645-1646.

Bromberg BE, Song IC, Mohn MP. (1965). The use of pig skin as a temporary biological dressing. Plastic and reconstructive surgery. 36: 80-90. https://doi.org/10.1097/00006534-196507000-00011; PMid:14310550

Brusselaers N, Pirayesh A, Hoeksema H, Richters CD, Verbelen J, Beele H, Blot SI, Monstrey S. (2010). Skin replacement in burn wounds. The Journal of trauma. 68 (2): 490-501. https://doi.org/10.1097/TA.0b013e3181c9c074; PMid:20154563

Burleson R, Eiseman B. (1973). Mechanisms of antibacterial effect of biologic dressings. Annals of surgery. 177 (2): 181-186. https://doi.org/10.1097/00000658-197302000-00010; PMid:4572783 PMCid:PMC1355561

Busby SA, Robb A, Lang S, Takeuchi Y, Vesely P, Scobie L. (2014). Antibiotic susceptibility and resistance of Staphylococcus aureus isolated from fresh porcine skin xenografts: risk to recipients with thermal injury. Burns: journal of the International Society for Burn Injuries. 40 (2): 288-294. https://doi.org/10.1016/j.burns.2013.06.006; PMid:23850162

Chang WH, Gomez NH, Edelstein LM. (1973). Use of lyophilised pig skin for donor site cover. British journal of plastic surgery. 26 (2): 147-149. https://doi.org/10.1016/S0007-1226(73)80008-6

Chiu T, Burd A. (2005). "Xenograft" dressing in the treatment of burns. Clinics in dermatology. 23 (4): 419-423. https://doi.org/10.1016/j.clindermatol.2004.07.027; PMid:16023938

Chiu T, Shah M. (2002). Porcin xenograft dressing for facial burns: beware of the mesh imprint. Burns: journal of the International Society for Burn Injuries. 28 (3): 279-282. https://doi.org/10.1016/S0305-4179(02)00009-8

Cooper DK. (1997). Xenografting - the early, early years. The British Transplantation Society. 5: 21-22.

Costa BA, Lima Júnior EM, de Moraes Filho MO, Fechine FV, de Moraes M, Silva Júnior FR, do Nascimento Soares M, Rocha M. (2019). Use of Tilapia Skin as a Xenograft for Pediatric Burn Treatment: A Case Report. Journal of burn care & research: official publication of the American Burn Association. 40 (5): 714-717. https://doi.org/10.1093/jbcr/irz085; PMid:31112268

Cronin H, Goldstein G. (2013). Biologic skin substitutes and their applications in dermatology. Dermatologic surgery: official publication for American Society for Dermatologic Surgery. 39 (1; 1): 30-34. https://doi.org/10.1111/j.1524-4725.2012.02561.x; PMid:22928551

Cullen B, Watt PW, Lundqvist C, Silcock D, Schmidt RJ, Bogan D, Light ND. (2002). The role of oxidised regenerated cellulose/collagen in chronic wound repair and its potential mechanism of action. The international journal of biochemistry & cell biology. 34 (12): 1544-1556. https://doi.org/10.1016/S1357-2725(02)00054-7

Denner J. (2021). Porcine Endogenous Retroviruses and Xenotransplantation, 2021. Viruses. 13 (11): 2156. https://doi.org/10.3390/v13112156; PMid:34834962 PMCid:PMC8625113

Denner J, Tönjes RR. (2012). Infection barriers to successful xenotransplantation focusing on porcine endogenous retroviruses. Clinical microbiology reviews. 25 (2): 318-343. https://doi.org/10.1128/CMR.05011-11; PMid:22491774 PMCid:PMC3346299

Elliott RA, Jr & Hoehn JG. (1973). Use of commercial porcine skin for wound dressings. Plastic and reconstructive surgery. 52 (4): 401-405. https://doi.org/10.1097/00006534-197352040-00013

Eriksson A, Burcharth J, Rosenberg J. (2013). Animal derived products may conflict with religious patients' beliefs. BMC medical ethics. 14: 48. https://doi.org/10.1186/1472-6939-14-48; PMid:24289542 PMCid:PMC4220589

Fishman JA. (2020). Prevention of infection in xenotransplantation: Designated pathogen-free swine in the safety equation. Xenotransplantation. 27 (3): e12595. https://doi.org/10.1111/xen.12595; PMid:32495461

Gu B. (1990). Clinical use of lyophilized porcine skin. Chinese journal of plastic surgery and burns. 6 (3): 205-239.

Haller HL, Blome-Eberwein SE, Branski LK, Carson JS et al. (2021). Porcine Xenograft and Epidermal Fully Synthetic Skin Substitutes in the Treatment of Partial-Thickness Burns: A Literature Review. Medicina (Kaunas, Lithuania). 57 (5): 432. https://doi.org/10.3390/medicina57050432; PMid:33946298 PMCid:PMC8146423

Hermans MH. (2014). Porcine xenografts vs. (cryopreserved) allografts in the management of partial thickness burns: is there a clinical difference? Burns: journal of the International Society for Burn Injuries. 40 (3): 408-415. https://doi.org/10.1016/j.burns.2013.08.020; PMid:24018214

Horner BM, Randolph MA, Huang CA, Butler PE. (2008). Skin tolerance: in search of the Holy Grail. Transplant international: official journal of the European Society for Organ Transplantation. 21 (2): 101-112. https://doi.org/10.1111/j.1432-2277.2007.00559.x; PMid:17903184

Hosseini SN, Mousavinasab SN, Fallahnezhat M. (2007). Xenoderm dressing in the treatment of second degree burns. Burns: journal of the International Society for Burn Injuries. 33 (6): 776-781. https://doi.org/10.1016/j.burns.2006.10.396; PMid:17524562

Hosseini SN, Mousavinasab SN, Rahmanpour H, Fallahnezhad M. (2009). A biological dressing versus 'conventional' treatment in patients with massive burns: a clinical trial. Turkish journal of trauma & emergency surgery. 15 (2): 135-140.

Kalsi R, Messner F, Brandacher G. (2020). Skin xenotransplantation: technological advances and future directions. Current opinion in organ transplantation. 25 (5): 464-476. https://doi.org/10.1097/MOT.0000000000000798; PMid:32773504

Kastner KH, Wünsch PH, Eckert P. (1988). Temporary skin replacement with lyophilized swine skin and foam substances - comparative experimental studies. Langenbecks Archiv fur Chirurgie. 373 (5): 287-297. https://doi.org/10.1007/BF01276544; PMid:3077419

Kiene S, Schill H, Roewer J, Frick U. (1976). Lyophilized split pigskin for biological wound dressings. Zentralblatt fur Chirurgie. 101 (24): 1481-1494.

Kimsa-Dudek M, Strzalka-Mrozik B, Kimsa MW, Blecharz I et al. (2015). Screening pigs for xenotransplantation: expression of porcine endogenous retroviruses in transgenic pig skin. Transgenic research. 24 (3): 529-536. https://doi.org/10.1007/s11248-015-9871-y; PMid:25812516

Lee YC. (1972). Early heterografting of partial-thickness burns. The Journal of trauma. 12 (9): 818-820. https://doi.org/10.1097/00005373-197209000-00012; PMid:4403720

Leto Barone AA, Mastroianni M, Farkash EA, Mallard C, Albritton A, Torabi R et al. (2015). Genetically modified porcine split-thickness skin grafts as an alternative to allograft for provision of temporary wound coverage: preliminary characterization. Burns: journal of the International Society for Burn Injuries. 41 (3): 565-574. https://doi.org/10.1016/j.burns.2014.09.003; PMid:25406888

Lima Júnior EM, De Moraes Filho MO, Costa BA, Rohleder A, Sales Rocha MB et al. (2020). Innovative Burn Treatment Using Tilapia Skin as a Xenograft: A Phase II Randomized Controlled Trial. Journal of burn care & research: official publication of the American Burn Association. 41 (3): 585-592. https://doi.org/10.1093/jbcr/irz205; PMid:31900475

Martínez-Flores F, Chacón-Gómez M, Madinaveitia-Villanueva JA, Barrera-Lopez A, Aguirre-Cruz L, Querevalu-Murillo W. (2015). The clinical use of cryopreserved human skin allografts for transplantation. Cirugia y cirujanos. 83 (6): 485-491. https://doi.org/10.1016/j.circir.2015.06.004; PMid:26187707

Matoušková E, Mestak O. (2014). The effect of different biologic and biosynthetic wound covers on keratinocyte growth, stratification and differentiation in vitro. Journal of tissue engineering. 5: 2041731414554966. https://doi.org/10.1177/2041731414554966; PMid:25383177 PMCid:PMC4221924

Nagaichuk V, Khimich S, Zheliba M, Zhuchenko O, Povoroznik A et al. (2017). Modern technologies of treatment of patients with critical and supercritical burns. Reports of Vinnytsia National Medical University. 21 (2): 428-433.

Nagaychuk VI, Chornopischuk RM, Nazarchuk OA. (2021). Prompt neutralization of traumatic hyperthermic factors of burn injuries in children at the stages of self-help, mutual assistance and first aid. Paediatric Surgery. Ukraine. 1 (70): 38-44. https://doi.org/10.15574/PS.2021.70.38

Pavliuk B, Stechyshyn I, Kramar S, Chubka M, Hroshovyi T. (2021). The effect of gel "Xeliogel" at the stages of the regeneration of aseptic burn wound in the experiment. Polski merkuriusz lekarski: organ Polskiego Towarzystwa Lekarskiego. 49 (293): 352-355.

Pruitt Jr BA. (1997). The evolutionary development of biologic dressings and skin substitutes. The Journal of burn care & rehabilitation. 18 (1; 2): S2-S5. https://doi.org/10.1097/00004630-199701001-00002; PMid:9063797

Pruitt Jr BA, Levine NS. (1984). Characteristics and uses of biologic dressings and skin substitutes. Archives of surgery (Chicago, Ill.: 1960). 119 (3): 312-322. https://doi.org/10.1001/archsurg.1984.01390150050013; PMid:6365034

Rappaport I, Pepino AT, Dietrick W. (1970). Early use of xenografts as a biologic dressing in burn trauma. American journal of surgery. 120 (2): 144-148. https://doi.org/10.1016/S0002-9610(70)80102-7

Robinson J, Hanke C, Sengelmann R et al. (2005). Surgery of the skin procedural dermatology. Andrews' diseases of the skin: clinical dermatology. Philadelphia: Elsevier: 601-602.

Saricilar EC, Huang S. (2021). Comparison of porcine and human acellular dermal matrix outcomes in wound healing: a deep dive into the evidence. Archives of plastic surgery. 48 (4): 433-439. https://doi.org/10.5999/aps.2020.02306; PMid:34352957 PMCid:PMC8342249

Schlottmann F, Bucan V, Vogt PM, Krezdorn N. (2021). A Short History of Skin Grafting in Burns: From the Gold Standard of Autologous Skin Grafting to the Possibilities of Allogeneic Skin Grafting with Immunomodulatory Approaches. Medicina (Kaunas, Lithuania). 57 (3): 225. https://doi.org/10.3390/medicina57030225; PMid:33801228 PMCid:PMC7998351

Sokolic IH, Farpour A, Ulin AW, Howard J. (1960). The use of heterograft skin as a biological dressing. Surgical forum. 10: 847-849.

Switzer WE, Moncrief JA, Mills W Jr, Order SE, Lindberg RB. (1966). The use of canine heterografts in the therapy of thermal injury. The Journal of trauma. 6 (3): 391-398. https://doi.org/10.1097/00005373-196605000-00008; PMid:5327182

Tobin GR, Breidenbach WC 3rd, Ildstad ST, Marvin MM, Buell JF, Ravindra KV. (2009). The history of human composite tissue allotransplantation. Transplantation proceedings. 41 (2): 466-471. https://doi.org/10.1016/j.transproceed.2009.01.026; PMid:19328905

Troy J, Karlnoski R, Downes K, Brown KS, Cruse CW, Smith DJ, Payne WG. (2013). The Use of EZ Derm® in Partial-Thickness Burns: An Institutional Review of 157 Patients. Eplasty. 13: e14.

Vogt PM, Kolokythas P, Niederbichler A, Knobloch K, Reimers K, Choi CY. (2007). Innovative wound therapy and skin substitutes for burns. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 78 (4): 335-342. [Vogt PM, Kolokythas P, Niederbichler A, Knobloch K, Reimers K, Choi CY. (2007). Innovative Wundtherapie und Hautersatz bei Verbrennungen. Der Chirurg; Zeitschrift fur alle Gebiete der operativen Medizen. 78 (4): 335-342]. https://doi.org/10.1007/s00104-007-1325-5; PMid:17344999

Wang C, Zhang F, Lineaweaver WC. (2020). Clinical Applications of Allograft Skin in Burn Care. Annals of plastic surgery. 84 (3; 2): S158-S160. https://doi.org/10.1097/SAP.0000000000002282; PMid:32028339

Wood M, Hale HW Jr. (1972). The use of pigskin in the treatment of thermal burns. American journal of surgery. 124 (6): 720-723. https://doi.org/10.1016/0002-9610(72)90125-0

Woodroof A, Phipps R, Woeller C, Rodeheaver G, Naughton GK, Piney E, Hickerson W, Branski L, Holmes JH 4th. (2015). Evolution of a Biosynthetic Temporary Skin Substitute: A Preliminary Study. Eplasty. 15: e30.

Yamamoto T, Iwase H, King TW, Hara H, Cooper D. (2018). Skin xenotransplantation: Historical review and clinical potential. Burns: journal of the International Society for Burn Injuries. 44 (7): 1738-1749. https://doi.org/10.1016/j.burns.2018.02.029; PMid:29602717 PMCid:PMC6160369

Zajicek R, Matouskova E, Broz L, Kubok R, Waldauf P, Königova R. (2011). New biological temporary skin cover Xe-Derma(®) in the treatment of superficial scald burns in children. Burns: journal of the International Society for Burn Injuries. 37 (2): 333-337. https://doi.org/10.1016/j.burns.2010.07.009; PMid:21050661

Zaporozhan SY, Tuzyuk NV. (2021). Treatment of burns using xenotransplants, saturated with nanocrystals of silver. Bulletin of Medical and Biological Research. 3: 24-28. https://doi.org/10.11603/bmbr.2706-6290.2021.3.12562

Zhernov OA, Osadcha OI, Zhernov AO, Sochienkova LS, Kozinets GP. (2022). The use of methods of conservative therapy in children with post-burn scarring and their impact on connective tissue metabolism. Modern Pediatrics. Ukraine. 4 (124): 48-53. https://doi.org/10.15574/SP.2022.124.48

Zuo H, Song G, Shi W, Jia J, Zhang Y. (2016). Observation of viable alloskin vs xenoskin grafted onto subcutaneous tissue wounds after tangential excision in massive burns. Burns & trauma. 4: 23. https://doi.org/10.1186/s41038-016-0045-9; PMid:27574692 PMCid:PMC4964051

Downloads

Published

2022-09-30