DISCUSSION
SCAR, SCAR
This safety and efficacy study presents the first results of the use of a novel dermal substitute in patients with burn and reconstructive wounds. The results of this study show that, similar to other known dermal substitutes, early wound healing was delayed in comparison with STSG alone.Slow wound healing in the study areas was a reason to reoperate in five patients; in two cases, this concerned only the dermal matrix area, and in one case, only the standard treatment area was reoperated. It should be noted that reoperations are relatively frequent in patients with large burn wounds. This is illustrated by the fact that reoperations took place in three other patients because of slow wound healing, but these areas were not related to the study areas. Bacterial colonization in the dermal matrix-treated areas was possibly related to the extended wound-healing time. This was noted in 2 of 24 cases; in all other cases (13/24), both study areas were involved. The application of topical negative-pressure therapy in combination with a dermal substitute could potentially improve graft take and the rate of wound healingThree months postsurgery, a limited number of biopsies were analyzed using immunohistochemistry and RNA analysis.Scar elasticity parameters Uf and Ue as measured by the Cutometer were statistically better for dermal matrix-treated areas compared with standard treatment at 12 months. This outcome of dermal substitutes has also been observed in other studies.The fact that relatively small differences were found in scar quality between the dermal matrix and standard of care-treated areas could be related to the fact that the researchers used relatively small expansion rates for the mesh grafts of ratio 1:1.5. Previous research indicates that especially in wounds treated with a dermal substitute combined with largely expanded grafts, the relative benefit of the dermal substitute becomes greater.Currently, cell-seeded full-thickness skin substitutes are under development.