Use of Skin Substitutes in Adult Canadian Burn Centres

Abstract

Seventeen Canadian adult burn centres were surveyed to determine the pattern of use, cost and availability of nine skin substitutes. An equal number of centres in the United States with comparable bed capacities were approached for comparison. Eighty-eight per cent of the Canadian centres and 76% of the United States centres responded to the questionnaire. Human cadaver skin, pig skin and Biobrane were used by approximately twice as many United States centres as Canadian centres. Cultured epidermal autografts (CEAs) were used by 20% of the Canadian centres and 15% of the American centres. Opsite, Tegaderm and Duoderm were used widely in both countries. Alloderm was used only in the United States, and amnion was not used in either country. The most common use of each substitute varied among centres, however, the pattern of use was comparable between the two countries, with the exception that Biobrane was not used in Canada to cover donor site wounds. In the United States, 60% of cadaver skin and all CEAs were purchased from private companies, whereas use of these two relatively expensive skin substitutes in Canada was restricted to centres with access to hospital-affiliated skin banks or laboratories. With the dependence of Canadian centres on noncommercial sources of biological skin replacements, research development in established skin banks should be encouraged, and regional discrepancies regarding access to these facilities addressed.