Biologic Dressings,

Cutaneous biologic dressings have been useful and versatile in wound management of severely burned patients. Availability, relative costs, patient acceptability, and similarities to human skin have made porcine skin a satisfactory skin substitute. Porcine heterocraft, however, does not take because of its inability to vascularize. More exudation occurs beneath it. The current experience with amniotic membranes waves and wanes. The most effective biologic dressing continues to be homograft skin which can be obtained from human skin banks. Hospital-based programs can also be set up in areas where there is an active burn service with on-site homograft harvesting. The value of the frequently changed biologic dressings for burn wound management are 1 debriding eschar during the frequent changing of the biologic dressing 2 protecting exposed granulation tissue for which donor sites are not yet available for autografting 3 provide an effective cover for exposed healthy tissue beneath excision or other traumatic skin defects 4 decrease evaporative water loss and exudative protein loss 5 provide a convenient dressing that can be observed without additional therapy 6 decrease pain and permit more extensive physical therapy 7 document a major milestone in the well-being of the patient which is easily identified by both the patient and the staff. The search for skin substitutes will continue because of the importance of closing the open burn wound and allowing the restitution of normal host defense, metabolic and other physiologic functions in the severely burned patient. Author