Review of the Use of a Semisynthetic Bilaminar Skin Substitute in Dermatology and a Case Series Report of Its Utility in Mohs Surgery
May 2014 | Volume 13 | Issue 5 | Original Article | 537 | Copyright © May 2014
Julie Akiko Gladsjo MD PhD, Silvia Soohyun Kim BA, and Shang I Brian Jiang MD
Division of Dermatology, University of California, San Diego, San Diego, CA
Biobrane is a biosynthetic wound dressing that has been widely used in burn treatment and as a skin graft donor site dressing. Our aim for this review was to establish whether Biobrane serves as a useful tool for the field of Dermatology and Dermatologic surgery. It has been frequently used in the field of Dermatology for the management of burns, erosive skin diseases, laser procedures, and surgical procedures. From the past experiences evident in the literature and in our cases series, it has been shown to improve patient’s quality of life by reducing pain, healing time, and length of hospital stay. Our case series further demonstrate its use in temporary closures, delayed reconstructions, and secondary intention healing in Mohs surgery. Reports of successful use of Biobrane in the literature and in our case series support the fact that it is an effective therapeutic option to facilitate the healing process in the field of Dermatology and Dermatologic surgery. J Drugs Dermatol.
Biobrane (Smith & Nephew, London, UK) is a biosynthetic wound dressing that has been widely used in burn treatment and as a skin graft donor site dressing.1,2 It has been demonstrated to have many qualities that would make it useful in dermatology. Biobrane is composed of two fused layers: a nylon knitted mesh that is bonded to a thin semipermeable silicone membrane. The membrane allows egress of wound exudate, while preventing significant water loss and contamination. Type I porcine collagen is incorporated into to the surface, providing a scaffolding for an adherent fibrin clot. Biobrane is stretchable, flexible, and quickly becomes adherent to wounds. It is available in sheets of several sizes and as a glove. According to the manufacturer, it can safely be left in place for up to 14 days.
In Pruitt and Levine’s3 1984 comprehensive paper on the beneficial effects of biological dressings, the characteristics of an optimal skin substitute were outlined, among them: a lack of antigenicity; impermeability to microorganisms; water vapor transmission similar to normal skin; elasticity and flexibility in order to maintain contact with an irregular wound bed; sustained adherence to the wound bed; inhibition of bacterial growth; low cost; simple storage requirements; and a long shelf life. They reviewed the various skin substitutes and biological dressings available at the time, the published studies examining their relative advantages and disadvantages, and their efficacy at promoting wound healing. Their review noted that Biobrane used for coverage of split thickness skin graft donor sites was associated with reduced evaporative water loss and markedly reduced wound pain, while animal studies concluded that Biobrane met most of their listed recommendations,with the exception of direct inhibition of bacterial growth. They therefore concluded that Biobrane is among the best skin substitutes for “clean wounds” such as graft donor sites.
Since that article, various papers describing the use of Biobrane in burn treatment have been published so that reviews of this topic were warranted. Although study conclusions have been mixed, most studies examining the use of Biobrane have shown a decrease in total healing time, decreased patient pain, and lower associated treatment costs. There was no difference in infection rate when compared to conventional burn treatment such as silver sulfadiazine. For example, Mandal4 published an extensive review of Biobrane in the pediatric burn literature between 1980 and 2006, evaluating study design rigor as well as outcomes. He concluded that Biobrane appears to be superior to conservative treatment in terms of pain control, time to wound healing, and length of hospital stay, with reasonable treatment costs. However, most studies did not examine long-term outcomes, and there were almost no head-to-head trials comparing Biobrane to other synthetic skin substitutes. In the adult burn literature, similar findings have been reported. For example, in one of the few studies evaluating long-term follow-up, Zapata-Sirvent5 and colleagues compared Biobrane and Scarlet Red dressing for treatment of split thickness skin graft donor sites in 31 adult patients. Biobrane-treated wounds had less exudates on days 1 to 3, healed slightly sooner, and had lower subjective pain, consistent with the results of many other burn studies. However, no differences were apparent at 1-year long-term follow-up. Here we present a review of the literature of Biobrane’s use in Dermatology as well as our own experience with its use in Mohs surgery.