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The Cost of a Burnt Face: a Side-by-Side Comparison of Acellular Regenerative Templates
Wesley Sivak, Dominick Motto, Russell Kling, Guy Stofman.
University of Pittsburgh, Pittsburgh, PA, USA.

BACKGROUND: Management of the severely burned face remains a clinical challenge. Deep vascularized tissue beds limit scar contracture and speed time to definitive skin grafting, and acellular regenerative templates (ARTs) can be used to achieve this end. Many options are available to the reconstructive surgeon, but little data for direct comparison of products is available. Herein a case is presented where two ARTs were used side-by-side (i.e. - each reconstructing one hemi-face) to resurface a near total full thickness facial burn.
METHODS: A patient with 90% full thickness facial burns was treated with two differing ARTs, one to each hemi-face: Integra Dermal Regenerative Template (Integra Life Sciences, Inc. - Plainsboro, NJ) and ACell CytalTM Burn Matrix (Acell, Inc - Columbia, MD). A critical assessment of the outcomes as well as a cost-analysis was performed.
RESULTS: In our patient, a 90% facial burn measuring 28 x 22 cm was debrided and covered with cadaver allograft. On post-operative day 5 the cadaver skin was removed; the patient underwent application of two ARTs, one to each hemi-face. Definitive skin grafting 12 days later was performed over the DRTs with sheet grafts 20/1000 inch thick. Both hemi-faces healed in equivalent fashions with 100% graft take, without complication; no significant contractures were noted at 6-month follow-up. Blinded individuals were unable to distinguish any difference in treatment between the two hemi-faces. Significant cost differences were noted between the two products.
CONCLUSIONS: Coverage of facial burns with ARTs limit scar contracture and speed time to definitive grafting. In our analysis, significant cost differences were noted between two products with equivalent clinical results at 6-months follow-up.

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