The use of Biobrane for hand surgery in Epidermolysis bullosa.

Surgical treatment of hand contractures and pseudosyndactyly in Epidermolysis bullosa poses numerous medical and hospital management problems. For instance, the exceptional fragility of genetically defective epidermis may contribute to iatrogenic trauma or hamper and prolong healing. The interval between unavoidable contracture recurrences rarely exceeds 2 years; therefore, a search for quick treatment completion should be considered by the surgical teams. Because this goal is rarely achieved, even efforts aimed at facilitating operative procedures and improving patient comfort are often quite valuable. This study presents the initial results on the use of the Biobrane dressing in six cases with various degrees of hand contracture. Application of the product in the form of gloves was fast and easy, promoted epithelialisation and substantially reduced the risk of iatrogenic trauma during replacement of the dressings. The use of Biobrane also enabled rapid elimination of additional protective dressing layers, exposure of the healing skin and prevention of further epidermal maceration. However, the time and number of necessary procedures under anaesthesia was dependent upon the degree of hand deformity rather than on Biobrane use, so this treatment did not shorten the healing time to less than 4 weeks. Copyright 2009 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.