Five years of experience using a dermal substitute: indications, histologic studies, and first results using a new single-layer tool.

BACKGROUND: Dermal substitutes have been used in Europe since 1996 as a mean of reconstructing the dermal layer. OBJECTIVES: To introduce the dermal substitute as a dual-stage reconstructing procedure using the dual-layer version and as a single-stage procedure, combining the single layer with a skin graft to achieve immediate closure. Our further objective was to evaluate the persistence of a commercial dermal substitute in the host's dermal layer using serial histologic studies. MATERIALS AND METHODS: The dermal substitute used was a membrane made using a porous coprecipitate of type I bovine collagen and glycosaminoglycan organized in a three-dimensional structure that allows the host's cell to migrate into it. It is available in a double-layer structure, covered by a silicone sheet, and in a single-layer structure without silicon. RESULTS AND CONCLUSION: We describe the dermal substitute indications in dermatologic surgery and our first results with the single layer as a single-stage procedure with an 80% to 100% take rate. Our histological studies of both products show their perfect integration and the persistence of the peculiar three-dimensional structure (neodermis) 5 years from implantation of the dual-layer dermal substitute.