In this short video, we will be demonstrating the use of a skin substitute. Specifically, we will be reviewing the use of Permioderm B for temporary coverage of a mixed partial thickness burn. This is a biosynthetic temporary skin substitute similar to BioBrain, which has been used in burn care for many decades. The patient is a young male who sustained a 10% TBSA flame burn to his lower back and mid-back. Given his initial exam, he was taken to the OR for possible excision and grafting the following day. As you can see here, following cleansing of the wounds, a mixed pattern of partial thickness burns is present. This includes a rim of superficial partial thickness, a central portion of intermediate partial thickness, and small areas of deep partial thickness along the inferior border. We considered performing tangential excision and skin grafting of the deepest areas. An alternative approach would be a non-excisional debridement and placement of a temporary skin substitute that would physiologically close his wounds and allow for re-epithelialization. This would obviate the need for a skin graft donor site, allow faster return to function and discharge from the hospital, all while minimizing the number of painful dressing changes that the patient would have to endure otherwise. The first step is adequately preparing the wound bed with a non-excisional debridement. Here we use standard cautery scratch pads to facilitate the removal of any debris and bacteria prior to placing the skin substitute. This wound bed was then copiously irrigated with an antimicrobial solution. This is the appearance of the wound following our non-excisional debridement where you can see various wound depths represented. All tissue appears moist with no evidence of full thickness injury, which would be a contraindication to a temporary skin substitute. We then bring in the product, which is oriented with its silicone layer superficial. Staples are used to adhere the dressing and prevent motion and shearing. The skin substitute is then carefully secured with the appropriate amount of tension on the opposite side and any excess is cut away to fit the exact dimensions of the wound. This is the final on-table appearance and an outer dressing of Actico is applied followed by a burn net fest. The patient tolerated the procedure well with minimal post-operative pain and he was discharged the following day. He was seen one week post-op and reported he was doing very well with no pain. He had no significant restrictions and was ready to return to school. He presented one week later for a wound check and any non-adherent permeaderm was trimmed away. These areas were cleansed and within a few days had epithelialized fully. By week three, the wound was about 90% re-epithelialized and a small remaining piece of permeaderm was removed. The patient began regular bathing with spa application of Psyllidine. He is seen at week four fully re-epithelialized and back to all activities. The patient and his family expressed satisfaction with this approach. He reported minimal pain through the entire process and was able to successfully complete treatment as now a patient. He missed minimal amounts of school. We will continue to follow him to monitor for the development of thicker scarring along the inferior border where his burns took the longest to heal. However, it is expected he will have a superior cosmetic outcome than what we would see with the standard excision and grafting.

Permioderm B

biosynthetic skin substitute

non-excisional debridement

burn recovery

cosmetic outcome