Dermal regeneration templates (DRTs) are permanent skin substitutes used in the management of skin defects after the excision of burns or release of burn wound contractures. The goals of skin substitutes are the prevention of wound infection, maintenance of moist environment, and replacement of normal skin to restore function and aesthetics. DRTs provide a scaffold to replace the dermis, and support epidermal autografting. Despite constant evolution in the development of skin substitutes, no single product stands out as the gold standard for the treatment of burns.
For many years, Integra has been used as a biological dermal substitute for burns that extended through the dermis. Although a useful dermal regeneration template, Integra is not without the risk of infection, including reported cases of toxic shock syndrome in secondary burn reconstruction patients. NovoSorb Biodegradable Temporizing Matrix (BTM) is a recent addition to the surgical toolbox that temporises the wound and biodegrades after integration and establishment of dermal elements. Comparatively, BTM provides a synthetic DRT option, which offers a thick, durable framework for reconstruction, which is more resistant to infection.
Although the use of DRTs is a significant step in the reconstruction of severe burns, they still require autografting to replace the epidermis, unlike some of the bioengineered dermal-epidermal skin substitutes in development, and this can be problematic in patients with limited donor sites. As BTM is becomes more widely used, the logical progression is to explore definitive wound closure alternatives, such as autologous skin cell suspension and cultured epithelial autografts over a widely meshed split thickness skin graft.
This paper will review the literature on the use of DRTs for burn management, including the findings of the recent transition to the use of BTM for severe burns, and future options including cultured epithelial autografts over DRTS and dermal-epidermal substitutes.