- Email: [email protected]
Skin substitutes: Which one do we know, which one do we use?
JBUR-4305; No. of Pages 2 burns xxx (2014) xxx–xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Skin substitutes: Which one do we know, which one do we use? Sir, With great interest we have read the paper of Hermans [1], who stated that both allografts and xenografts seem to perform equally and clinically well with regard to healingrelated outcomes. Furthermore, they have discussed that the decision of choosing one type of biological dressing over another is mainly based on other aspects, such as biological safety, availability and price. We absolutely agree to the above-mentioned statements. In one of our recent studies (unpublished data), we have asked 500 burn experts worldwide about their preferences concerning biological dressings and skin substitutes. The study design of this study (online survey among burn care specialists) was comparable to former studies of our workgroup [2,3]. In this recent study, 32.4% of all study responders (n = 111 responders from 36 countries) stated that the factor ‘‘potential biological risk’’ is essential for their decision, which product to use. But we have to keep in mind that in reality the vast majority of all responders (85.6%) do not think that biological materials pose a real risk to patients. This is according to other studies, which stated that the risk of transferring donor pathogens (e.g. HTLV) is not really proven at this time [4]. Furthermore, the experts in our study stated that the factor prize is essential (33.3%) or important (46.0%). Therefore, it has to be pointed out that xenografts are much cheaper than its alternatives and thus are more likely to be used in low-income countries than in Europe or the United States. An interesting fact is that xenografts are only used by about 50% of all experts, while the other half refuses to use them. This may be very well contributed to the fact that xenotransplants are not used in many countries due to religious reasons. Cost effectiveness has been identified as one of the essential properties in our survey. This may be due to the fact that health-care systems all over the world have an ambition towards cost effective strategies. On the other hand, we can assume that especially in severe burns, big amounts of
skin substitutes are needed and thus cost effectiveness becomes even more important than in small sized injuries. Another part of cost effectiveness is clearly a readily availability of products. 47.8% of all our responders stated that availability is essential or at least desirable (45.9% of all responders). We think that almost all of the currently available products are used on a regular daily basis, while definite preferences among them are not clearly visible and not always objective. Probably every user has different preferences and requirements on the ideal skin substitute. At this moment we do not know in detail, which those are, but this could be a possible subject for further studies.
Conflict of interest statement None declared.
references
[1] Hermans MH. Porcine xenografts vs (cryopreserved) allografts in the management of partial thickness burns: is there a clinical difference? Burns 2013. http://dx.doi.org/ 10.1016/j.burns.2013.08.020. pii:S0305-4179(13)00259-3 [Epub ahead of print] PubMed PMID: 24018214. [2] Selig HF, Lumenta DB, Giretzlehner M, Jeschke MG, Upton D, Kamolz LP. The properties of an ideal burn wound dressing – what do we need in daily clinical practice? Results of a worldwide online survey among burn care specialists. Burns 2012;38(November (7)):960–6. [3] Kamolz LP, Giretzlehner M, Trop M, Parvizi D, Spendel S, Schintler M, et al. The properties of the ‘‘ideal’’ donor site dressing: results of a worldwide online survey. Ann Burns Fire Disasters 2013;26(3):136–41. [4] Fishman JA, Patience C. Xenotransplantation: infectious risk revisited. Am J Transplant 2004;4(9):1383–90.
Please cite this article in press as: Kamolz L-P, et al. Skin substitutes: Which one do we know, which one do we use? Burns (2014), http:// dx.doi.org/10.1016/j.burns.2014.02.012
JBUR-4305; No. of Pages 2
2
burns xxx (2014) xxx–xxx
Lars-Peter Kamolz* Hildegard Koller Daryousch Parvizi David B. Lumenta Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria
*Corresponding author E-mail address: [email protected] (L.-P. Kamolz)
http://dx.doi.org/10.1016/j.burns.2014.02.012 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
Please cite this article in press as: Kamolz L-P, et al. Skin substitutes: Which one do we know, which one do we use? Burns (2014), http:// dx.doi.org/10.1016/j.burns.2014.02.012
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Letter to the Editor
Skin substitutes: Which one do we know, which one do we use? Sir, With great interest we have read the paper of Hermans [1], who stated that both allografts and xenografts seem to perform equally and clinically well with regard to healingrelated outcomes. Furthermore, they have discussed that the decision of choosing one type of biological dressing over another is mainly based on other aspects, such as biological safety, availability and price. We absolutely agree to the above-mentioned statements. In one of our recent studies (unpublished data), we have asked 500 burn experts worldwide about their preferences concerning biological dressings and skin substitutes. The study design of this study (online survey among burn care specialists) was comparable to former studies of our workgroup [2,3]. In this recent study, 32.4% of all study responders (n = 111 responders from 36 countries) stated that the factor ‘‘potential biological risk’’ is essential for their decision, which product to use. But we have to keep in mind that in reality the vast majority of all responders (85.6%) do not think that biological materials pose a real risk to patients. This is according to other studies, which stated that the risk of transferring donor pathogens (e.g. HTLV) is not really proven at this time [4]. Furthermore, the experts in our study stated that the factor prize is essential (33.3%) or important (46.0%). Therefore, it has to be pointed out that xenografts are much cheaper than its alternatives and thus are more likely to be used in low-income countries than in Europe or the United States. An interesting fact is that xenografts are only used by about 50% of all experts, while the other half refuses to use them. This may be very well contributed to the fact that xenotransplants are not used in many countries due to religious reasons. Cost effectiveness has been identified as one of the essential properties in our survey. This may be due to the fact that health-care systems all over the world have an ambition towards cost effective strategies. On the other hand, we can assume that especially in severe burns, big amounts of
skin substitutes are needed and thus cost effectiveness becomes even more important than in small sized injuries. Another part of cost effectiveness is clearly a readily availability of products. 47.8% of all our responders stated that availability is essential or at least desirable (45.9% of all responders). We think that almost all of the currently available products are used on a regular daily basis, while definite preferences among them are not clearly visible and not always objective. Probably every user has different preferences and requirements on the ideal skin substitute. At this moment we do not know in detail, which those are, but this could be a possible subject for further studies.
Conflict of interest statement None declared.
references
[1] Hermans MH. Porcine xenografts vs (cryopreserved) allografts in the management of partial thickness burns: is there a clinical difference? Burns 2013. http://dx.doi.org/ 10.1016/j.burns.2013.08.020. pii:S0305-4179(13)00259-3 [Epub ahead of print] PubMed PMID: 24018214. [2] Selig HF, Lumenta DB, Giretzlehner M, Jeschke MG, Upton D, Kamolz LP. The properties of an ideal burn wound dressing – what do we need in daily clinical practice? Results of a worldwide online survey among burn care specialists. Burns 2012;38(November (7)):960–6. [3] Kamolz LP, Giretzlehner M, Trop M, Parvizi D, Spendel S, Schintler M, et al. The properties of the ‘‘ideal’’ donor site dressing: results of a worldwide online survey. Ann Burns Fire Disasters 2013;26(3):136–41. [4] Fishman JA, Patience C. Xenotransplantation: infectious risk revisited. Am J Transplant 2004;4(9):1383–90.
Please cite this article in press as: Kamolz L-P, et al. Skin substitutes: Which one do we know, which one do we use? Burns (2014), http:// dx.doi.org/10.1016/j.burns.2014.02.012
JBUR-4305; No. of Pages 2
2
burns xxx (2014) xxx–xxx
Lars-Peter Kamolz* Hildegard Koller Daryousch Parvizi David B. Lumenta Division of Plastic, Aesthetic and Reconstructive Surgery, Research Unit for Tissue Regeneration, Repair and Reconstruction, Department of Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036 Graz, Austria
*Corresponding author E-mail address: [email protected] (L.-P. Kamolz)
http://dx.doi.org/10.1016/j.burns.2014.02.012 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
Please cite this article in press as: Kamolz L-P, et al. Skin substitutes: Which one do we know, which one do we use? Burns (2014), http:// dx.doi.org/10.1016/j.burns.2014.02.012