Invited Commentary

Invited Commentary Eur J Plast Surg (2000) 23:309 © Springer-Verlag 2000 The use of artificial skin substitutes in wound healing ing. It is unclear from the article whether the dermal sub- is the subject of much current debate. The authors in- stitute has additional value. Do the authors have a view troduce Pelnac, which would appear to be rather simi- on this? Have they examined biopsy material to deter- lar to Integra, and claim satisfactory take with this mine whether the dermal component has survived in the product on exposed bone. As the initial vascularisation grafted wound? of skin substitutes is perceived to be problematic, satis- A second major problem with dermal substitutes is factory take on bone is, at first sight, a noteworthy their vulnerability to infection. Indeed, the authors stress achievement. this drawback. I am curious to know why only 13 of the However, there has to be a question regarding the vas- 52 cases presenting at their clinic were treated with the cular ingrowth of the dermal component. At our burn dermal substitute. Were the remaining cases “unsuit- centre, similar results to those described are obtained, able”, and if so, why? This question is important because using allograft skin applied to abraded bone, producing a the practical applicability of skin substitutes, particularly vascularised wound bed which is suitable for autograft- in burns which are usually bacterially contaminated, re- mains unclear. Following from this, I miss a clear state- ment from the authors describing which wounds are suit- D. P. Mackie ( ) Red Cross Hospital, 1942 LE Beverwijk, The Netherlands able for treatment with a dermal substitute. European Journal of Plastic Surgery Springer Journals

Invited Commentary

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Copyright © 2000 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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