Terapia de vacío como adyuvante para el uso de sustitutos dérmicos monocapa

Abstract

Split thickness autografts are the gold standard for wound coverage. However, scars and retractions are frequent after skin grafts, and would be severe over special regions. Different authors avoid these complications using a dermal substitute interposed between the wound and the skin graft in the first surgical time. A prospective study was designed to evaluate the split thickness skin graft uptake time over a monolayer matrix, with and without a vacuum assisted therapy device (VAC®). Twenty patients with a full thickness wound over a special region were randomized between 2 groups. Epidemiological data and wound etiology (acute burn, burn sequelae or donor site after a fasciocutaneous flap raised) were collected. Matriderm ® (mono layer dermal substitute) and a split thickness skin graft was applied over 10 cases (Group I). The dressing was changed after 7 days, and every 3-4 days until the skin graft was uptake and stable. Another 10 cases were treated with the same surgical strategy (Group II). After surgery, a vacuum assisted therapy device (VAC®) was applied until the graft was uptake. The skin graft evaluation was done by a blind observer. All complications were reported until 3 months after the skin graft was stable. The homogeneity between groups was assessed. Averaged uptake time was 17, 6 ± 8 days, and the total complication rate was 20%. Statistically differences were not found between the 2 groups for the complication rate. The uptake time was 21,4 ± 9 days in the Group I and 13,9 ± 4 days in the Group II. These differences was statically significative. As a conclusion, the use of monolayer dermal substitutes is safe, with skin graft uptake rate of 85%. Time for skin graft uptake over a monolayer dermal matrix is shorter using a VAC ® device over the skin graft, with similar complication rate.