Efficacy of artificial dermis in repairing small to medium-sized deep partial-thickness scalds in infants and young children

Ding Xionghui; Xiao Jun; Li Tianwu; Mao Xiaobo; Zhou Rong; Qiu Lin

doi:10.3760/cma.j.cn501225-20250512-00219

Volume 41 Issue 8

Aug. 2025

Turn off MathJax

Article Contents

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2025 > 41(8): 759-767

Ding XH,Xiao J,Li TW,et al.Efficacy of artificial dermis in repairing small to medium-sized deep partial-thickness scalds in infants and young children[J].Chin J Burns Wounds,2025,41(8):759-767.DOI: 10.3760/cma.j.cn501225-20250512-00219.

Citation:

PDF( 0 KB)

Efficacy of artificial dermis in repairing small to medium-sized deep partial-thickness scalds in infants and young children

doi: 10.3760/cma.j.cn501225-20250512-00219

Department of Burn and Plastic Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center of Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing 400014, China

Funds:

Chongqing Medical Scientific Research Project (Joint Project of Chongqing Health Commission and Science and Technology Bureau, 2024GDRC010) 2024GDRC010

More Information

Corresponding author: Qiu Lin, Email: qiulin118@126.com
Received Date: 2025-05-12

Abstract

Abstract

Objective To investigate the efficacy of artificial dermis in repairing small to medium-sized deep partial-thickness scalds in infants and young children. Methods The study was a retrospective observational study. From June 2022 to October 2024, 149 infants and young children with small to medium-sized deep partial-thickness scalds meeting the inclusion criteria were admitted to the Children's Hospital of Chongqing Medical University (hereinafter referred to as our institution). There were 96 males and 53 females, aged from 2 days to 3 years. Based on wound management method, the children were divided into debridement-alone group (n=55), artificial dermis group (n=31), autologous split-thickness skin group (n=36), and combined skin grafting group (n=27). Wounds in the first group of children underwent debridement alone. Wounds in the latter three groups of children were treated with artificial dermis transplantation, autologous split-thickness skin grafts transplantation, or artificial dermis combined with autologous split-thickness skin grafts transplantation, respectively, following debridement. Donor sites for autologous split-thickness skin grafts were the head, back, or lateral thigh. After debridement, wound secretion specimens were collected from the debridement-alone group and artificial dermis group of children for microbial detection, the detection rate was calculated, and wound infection was observed. Wound healing time and length of hospital stay (referring to the length of hospital stay in the Department of Burn and Plastic Surgery of our institution, the same hereafter) were recorded in four groups of children. At the 6-month follow-up after wound healing, the scar (referring to primary wound site scars, the same hereafter) condition of four groups of children was assessed using the modified Vancouver scar scale (mVSS), and both total mVSS score and pliability score were recorded. The total mVSS score of scars was the primary outcome indicator; other indicators were secondary outcome. Results After debridement, the microbial detection rate in wound secretion specimens of children in debridement-alone group was 29.1% (16/55), significantly higher than 9.7% (3/31) in artificial dermis group, χ²=4.34, P<0.05. Wound infection occurred in 2 children in debridement-alone group, whereas no wound infection occurred in children in artificial dermis group. Compared with that in debridement-alone group, the wound healing time of children in artificial dermis group, autologous split-thickness skin group, and combined skin grafting group was significantly shortened (P<0.05). Compared with that in artificial dermis group, the wound healing time of children in autologous split-thickness skin group was significantly shortened (P<0.05). Compared with that in autologous split-thickness skin group, the wound healing time of children in combined skin grafting group was significantly prolonged (P<0.05). Compared with that in debridement-alone group, the length of hospital stay of children in artificial dermis group and autologous split-thickness skin group was significantly shortened (P<0.05). Compared with that in artificial dermis group, the length of hospital stay of children in autologous split-thickness skin group was significantly shortened (P<0.05), the length of hospital stay of children in combined skin grafting group was significantly prolonged (P<0.05). Compared with that in autologous split-thickness skin group, the length of hospital stay of children in combined skin grafting group was significantly prolonged (P<0.05). At the 6-month follow-up after wound healing, the total mVSS score of scars of children in debridement-alone group was 8.1±1.1, significantly higher than 6.8±0.9 in artificial dermis group (with mean difference of 1.3, 95% confidence interval of 0.8 to 1.8, P<0.05), and significantly lower than 9.4±1.5 in autologous split-thickness skin group (with mean difference of -1.3, 95% confidence interval of -1.8 to -0.8, P<0.05). Compared with that in artificial dermis group, the total mVSS score of children in autologous split-thickness skin group was significantly increased (with mean difference of -2.6, 95% confidence interval of -3.2 to -2.0, P<0.05). Compared with that in autologous split-thickness skin group, the 7.7±1.0 of total mVSS score of children in combined skin grafting group was significantly decreased (with mean difference of 1.7, 95% confidence interval of 1.1 to 2.3, P<0.05). Compared with that in debridement-alone group, the scar pliability score of children in artificial dermis group was significantly decreased (P<0.05). Compared with that in artificial dermis group, the scar pliability score of children in autologous split-thickness skin group was significantly increased (P<0.05). Compared with that in autologous split-thickness skin group, the scar pliability score of children in combined skin grafting group was significantly decreased (P<0.05). Conclusions Artificial dermis used for the repair of small to medium-sized deep partial-thickness scald wounds in infants and young children can improve scar quality, reduce the risk of wound infection, and relatively shorten wound healing time. It is particularly suitable for infants and young children whose aesthetic and functional outcomes are prioritized.
- Burns,
- Cicatrix,
- Artificial dermis,
- Infants and young children,
- Deep partial-thickness burns,
- Wound repair,
- Modified Vancouver scar scale,
- Curative effect

FullText(HTML)

References(34)

References

[1]	HanD, WeiY, LiY, et al. Epidemiological and clinical characteristics of 5,569 pediatric burns in central China from 2013 to 2019[J]. Front Public Health, 2022,10:751615. DOI: 10.3389/fpubh.2022.751615.
[2]	YangJ, TianG, LiuJ, et al. Epidemiology and clinical characteristics of burns in mainland China from 2009 to 2018[J/OL]. Burns Trauma, 2022,10:tkac039[2025-05-12]. https://pubmed.ncbi.nlm.nih.gov/36196302/. DOI: 10.1093/burnst/tkac039.
[3]	中华医学会烧伤外科学分会. 儿童深Ⅱ度烧伤创面处理专家共识(2023版)[J].中华烧伤与创面修复杂志,2023,39(10):901-910. DOI: 10.3760/cma.j.cn501225-20230730-00026.
[4]	中华医学会烧伤外科学分会, 海峡两岸医药卫生交流协会暨烧创伤组织修复专委会. Ⅱ度烧伤创面治疗专家共识(2024版)Ⅰ:院前急救和非手术治疗[J].中华烧伤与创面修复杂志,2024,40(1):1-18. DOI: 10.3760/cmaj.cn501225-20231019-00120.
[5]	YapN, VankayalapatiDK, LeeSC, et al. Healing rates and dressing frequency of silver foam dressings in paediatric burns: a systemic review and meta-analysis[J]. Eur Burn J, 2025,6(1):3. DOI: 10.3390/ebj6010003.
[6]	WuJJ, ZhangF, LiuJ, et al. Effect of silver-containing hydrofiber dressing on burn wound healing: a meta-analysis and systematic review[J]. J Cosmet Dermatol, 2023,22(5):1685-1691. DOI: 10.1111/jocd.15639.
[7]	WangJ, YangB, ZhangXH, et al. The effectiveness of silver-containing hydrofiber dressing compared with topical silver sulfadiazine cream in pediatric patients with deep partial-thickness burns: a retrospective review[J]. Wound Manag Prev, 2022,68(3):29-36.
[8]	LouJ, ZhuX, XiangZ, et al. The efficacy and safety of negative pressure wound therapy in paediatric burns: a systematic review and meta-analysis of randomized controlled trials[J]. BMC Pediatr, 2024, 24(1):807. DOI: 10.1186/s12887-024-05302-z.
[9]	PressI, MoiemenN, AhmedZ. Efficacy and complications associated with acellular dermal substitute use in the treatment of acute burns: a systematic review and meta-analysis[J]. Eur Burn J, 2023,4(4):548-562. DOI: 10.3390/ebj4040036.
[10]	YehJP, LinKC. Comparison between artificial dermis with split-thickness skin graft and full-thickness skin graft for reconstruction of joint-involved burn wounds: a retrospective review from a tertiary burn centre[J]. Int Wound J, 2025,22(1):e70116. DOI: 10.1111/iwj.70116.
[11]	MoraesF, Ferraz BarbosaB, SepulvidaD, et al. Nile tilapia skin xenograft versus silver-based dressings in the management of partial-thickness burn wounds: a systematic review and meta-analysis[J]. J Clin Med, 2024,1 3(6):1642. DOI: 10.3390/jcm13061642.
[12]	LenzM, AllortoN, ChamaniaS, et al. Availability, effectiveness and safety of cadaveric and fresh allogeneic skin grafts in pediatric burn care-a review[J]. Cell Tissue Bank, 2025,26(2):16. DOI: 10.1007/s10561-025-10161-8.
[13]	BaryzaMJ, BaryzaGA. The Vancouver Scar Scale: an administration tool and its interrater reliability[J]. J Burn Care Rehabil, 1995,16(5):535-538. DOI: 10.1097/00004630-199509000-00013.
[14]	PantaloneD, BergaminiC, MartellucciJ, et al. The role of DAMPS in burns and hemorrhagic shock immune response: pathophysiology and clinical issues. Review[J]. Int J Mol Sci, 2021, 22(13):7020. DOI: 10.3390/ijms22137020.
[15]	RaniM, NicholsonSE, ZhangQ, et al. Damage-associated molecular patterns (DAMPs) released after burn are associated with inflammation and monocyte activation[J]. Burns, 2017,43(2):297-303. DOI: 10.1016/j.burns.2016.10.001.
[16]	JabarkhylD, Perusseau-LambertA, FasuyiJ, et al. The efficacy of biobrane in managing superficial paediatric burn injuries: a systematic review and meta-analysis[J]. Cureus, 2025,17(2):e78508. DOI: 10.7759/cureus.78508.
[17]	van den BoschAS, VerwilligenR, PijpeA, et al. Outcomes of dermal substitutes in burns and burn scar reconstruction: a systematic review and meta-analysis[J]. Wound Repair Regen, 2024,32(6):960-978. DOI: 10.1111/wrr.13226.
[18]	KashimuraT, NagasakiK, HorigomeM, et al. Selection of artificial dermis for shortening treatment period: Integra versus Pelnac[J]. Plast Reconstr Surg Glob Open, 2021,9(6):e3599. DOI: 10.1097/GOX.0000000000003599.
[19]	BurkeJF, ⅣYannas, QuinbyWCJr, et al. Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury[J]. Ann Surg, 1981,194(4):413-428. DOI: 10.1097/00000658-198110000-00005.
[20]	HsuKF, ChiuYL, ChiaoHY, et al. Negative-pressure wound therapy combined with artificial dermis (Terudermis) followed by split-thickness skin graft might be an effective treatment option for wounds exposing tendon and bone: a retrospective observation study[J]. Medicine (Baltimore), 2021,100(14):e25395. DOI: 10.1097/MD.0000000000025395.
[21]	LvZ, WangQ, JiaR, et al. Pelnac^® artificial dermis assisted by VSD for treatment of complex wound with bone/tendon exposed at the foot and ankle, a prospective study[J]. J Invest Surg, 2020,33(7):636-641. DOI: 10.1080/08941939.2018.1536177.
[22]	GardienK, PijpeA, BrouwerKM, et al. Short- and long-term outcomes of an acellular dermal substitute versus standard of care in burns and reconstructions: a phase Ⅰ/Ⅱ intrapatient randomized controlled trial[J]. Adv Skin Wound Care, 2023,36(10):540-548. DOI: 10.1097/ASW.0000000000000040.
[23]	WardhanaA, ValeriaM. Efficacy of skin substitutes for management of acute burn cases: a systematic review[J]. Ann Burns Fire Disasters, 2022,35(3):227-236.
[24]	QuadriM, BaudouinC, LottiR, et al. Characterization of skin interfollicular stem cells and early transit amplifying cells during the transition from infants to young children[J]. Int J Mol Sci, 2024,25(11):5635.DOI: 10.3390/ijms25115635.
[25]	SielatyckaK, Poniewierska-BaranA, NurekK, et al. Novel view on umbilical cord blood and maternal peripheral blood-an evidence for an increase in the number of circulating stem cells on both sides of the fetal-maternal circulation barrier[J]. Stem Cell Rev Rep, 2017,13(6):774-780. DOI: 10.1007/s12015-017-9763-z.
[26]	LonieS, BakerP, TeixeiraRP. Healing time and incidence of hypertrophic scarring in paediatric scalds[J]. Burns, 2017,43(3):509-513. DOI: 10.1016/j.burns.2016.09.011.
[27]	van den BoschAS, VerwilligenR, PijpeA, et al. Indications for the use of dermal substitutes in patients with acute burns and in reconstructive surgery after burns: a systematic review[J]. Wound Repair Regen, 2025,33(1):e13248. DOI: 10.1111/wrr.13248.
[28]	HicksKE, HuynhMN, JeschkeM, et al. Dermal regenerative matrix use in burn patients: a systematic review[J]. J Plast Reconstr Aesthet Surg, 2019,72(11):1741-1751. DOI: 10.1016/j.bjps.2019.07.021.
[29]	ShangF, LuYH, GaoJ, et al. Comparison of therapeutic effects between artificial dermis combined with autologous split-thickness skin grafting and autologous intermediate-thickness skin grafting alone in severely burned patients: a prospective randomised study[J]. Int Wound J, 2021,18(1):24-31. DOI: 10.1111/iwj.13518.
[30]	CorrêaFB, CastroJ, AlmeidaIR, et al. Evaluation of contraction of the split-thickness skin graft using three dermal matrices in the treatment of burn contractures: a randomised clinical trial[J]. Wound Repair Regen, 2022,30(2):222-231. DOI: 10.1111/wrr.13002.
[31]	AlmeidaIR, GonqalvesAC, CorrêaFB, et al. Evaluation of clinical and biomechanical features of scars resulting from the treatment of burn contractures comparing acellular dermal matrices: a randomized clinical trial[J]. Ann Surg, 2023,277(2):198-205. DOI: 10.1097/SLA.0000000000005371.
[32]	AlsaifA, KaramM, HayreA, et al. Full thickness skin graft versus split thickness skin graft in paediatric patients with hand burns: systematic review and meta-analysis[J]. Burns, 2023,49(5):1017-1027. DOI: 10.1016/j.burns.2022.09.010.
[33]	GreenhalghDG, HinchcliffK, SenS, et al. A ten-year experience with pediatric face grafts[J]. J Burn Care Res, 2013,34(5):576-584. DOI: 10.1097/BCR.0b013e3182a22ea5.
[34]	FrameJD, StillJ, Lakhel-LeCoadouA, et al. Use of dermal regeneration template in contracture release procedures: a multicenter evaluation[J]. Plast Reconstr Surg, 2004,113(5):1330-1338. DOI: 10.1097/01.prs.0000111883.93604.85.