Dermal Substitutes and Negative-Pressure Wound Therapy for Burns and Scars

After a half-century of research and clinical practice, dermal substitutes and negative-pressure wound therapy (NPWT) have found their place in the reconstructive ladder. Dermal substitutes, such as AlloDerm and Integra, were originally developed to be a lifesaving product for large burns. They have since been applied to a myriad of other clinical applications, including acute burns of all sizes, hypertrophic scar and keloids, traumatic wounds with exposed bone and tendon, and oncologic soft tissue defects. Early studies found that NPWT accelerated the engraftment of dermal substitutes, and so these two technologies have been used synergistically for over a decade. This chapter provides a historical overview of dermal substitutes and NPWT, describes how dermal substitutes can lead to the formation of a neodermis, and explores some of the many clinical applications. The two-stage surgical technique for skin reconstruction, using Integra, NPWT, and delayed split-thickness skin graft, is also described.