Biomedical Engineering Reference
In-Depth Information
Fig. 5.3
The patient had
deep loss of skin over the
entire right side of the face.
He was treated with DRT,
as well as an autoepidermal
graft, and acquired new skin,
though without hair follicles.
(Photo courtesy of J. F.
Burke, MD)
to the macromolecular components of DRT, bovine skin collagen and chondroitin
6-sulfate. The overall conclusion from the clinical study was that DRT presented
few, if any, humoral immunological problems to patients (Michaeli and McPherson
1990). Other clinical studies of DRT with massively burned patients have empha-
sized follow-up of pediatric patients over a 6-year (Burke 1987; Tompkins et al.
1989) or 10-year period (Sheridan et al. 1994). The new integument was reported to
be free of restrictions to joint function, indicative of absence of contractures; most
interestingly, the new skin had the ability of growing as the child grew (Burke 1987;
Sheridan et al. 1994). A study with 11 patients who were being treated with DRT
for deep hand burns showed that the treated skin sites were flexible and supple and
did not adhere to the deeper layers, thereby permitting free articular and functional
movement (Dantzer et al. 2003). The burned breast was reconstructed with DRT
and the authors reported the presence of elastin fibers throughout the neodermis,
as well as superior patient satisfaction to treatment with thick split-thickness graft-
ing (Palao et al. 2003). Objective evaluation of skin resulting from treatment with
the DRT and with split-thickness skin grafts (SSGs) in six burn patients, using an
instrumented suction device (Cutometer) showed that the elastic properties of sites
grafted with DRT were comparable to normal skin while those treated with SSG
were not (Nguyen et al. 2010). Two views of the new skin with patients following
use of DRT are shown (Figs.
5.3
and
5.4
).
A few additional recent clinical studies are referred to below, indicative of the
very wide range of applicability of DRT. They will not be discussed in detail.
Chronic and pathological skin wounds were treated with this device in a study of
111 patients (Gottlieb and Furman 2004). Release of contractures was treated in a
multicenter trial with 89 patients (Frame et al. 2004). Recent studies have included
treatment for skin tumors related both to melanoma and nonmelanoma skin cancers
(Muller et al. 2013), treatment of bone exposure (Yeong et al. 2012), skin avulsion
injuries in the upper extremity (Demiri et al. 2013), coverage of amputation stumps
