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Background:
While autologous skin grafts are the best definitive coverage of burn wounds requiring grafting, insufficient quantities of donor skin or unsuitable recipient beds often make autografting a suboptimal option for early excisions and grafting. Nonetheless, early coverage of wounds with an epidermal layer helps decrease metabolic rate, heat and fluid loss, microbial colonization, additional physical trauma, and pain. Skin substitutes such as allografts and xenografts are routinely used for temporary coverage of deep dermal and full thickness wounds prior to autografting. This study aimed to investigate outcome differences between allograft and xenograft by analyzing time to healing, graft complication rates, rates of aesthetic and functional deformity, and cost.
Methods: A retrospective review of adult and pediatric records from an American Burn Association verified burn center over a 19-month period from November 2013 to May 2015 was performed. Patients included received allografting or xenografting followed by autografting for a burn injury. Data points included patient demographics, burn etiology and location, graft measurements, procedure time, percent graft take, time to complete re-epithelialization, complications following grafting, and cost.
Results: 77 patients were included, comprising 187 skin graft sites. 52 patients received wound coverage with allograft and 25 patients received wound coverage with xenograft, which translated to 122 allografted and 65 xenografted sites. Third degree burns represented the major burn degree for patients undergoing allografting or xenografting (92.6% vs 92.3%, p = 0.94, respectively). Average grafted area was 450.9 ± 618.6 cm² per patient in the allograft group and 477.0 ± 866.2 cm² per patient in the xenograft group (p = 0.88). There was a trend toward shorter procedure and total operating room times when using xenograft versus allograft. Average total operating time per cm² area grafted was less when using xenograft versus allograft (10.1 vs 13.0 seconds per cm² grafted). Total procedure time was also lower in the xenograft versus allograft group (4.6 vs 6.5 seconds per cm² grafted). All patients received a split-thickness skin graft following temporary coverage of their burn wounds with allograft or xenograft. Average autografted area was 429.1 ± 620.6 cm² per patient in the allograft group and 287.0 ± 435.4 cm² per patient in the xenograft group (p = 0.60). Average time to complete re-epithelialization was 44.1 ± 14.0 days in the allograft group and 45.2 ± 17.9 days in the xenograft group (p = 0.66). Complications following autografting in the allograft versus xenograft groups included hypertrophic scaring (27.9% vs. 20.0%; p = 0.25), hypersensitivity (7.4% vs. 12.3%; p = 0.26), and decreased range of motion (10.7% vs. 12.3%; p = 0.73). There was a significantly higher rate of dyschromia in the allograft versus xenograft group (23.8% vs. 7.79%; p = 0.01).
Conclusions:
Xenograft is an effective, cheaper, and more readily available alternative to allograft for temporary burn coverage and does not confer increased risk of aesthetic or functional deformity, nor does it negatively impact time to healing.