311 Bilayer Dermal Regeneration Matrix Use in Burn Patients: A Systematic Review
Bibliographic record
Abstract
Dermal regeneration matrix (DRM) has been used for several decades in the setting of acute and reconstructive burn surgery. While multiple studies have demonstrated success with DRM, there has not been a comprehensive evaluation of the literature that synthesizes its expected outcomes. Comprehensive searches of MEDLINE, EMBASE, CINAHL, and Cochrane Library were performed for the period 1989-2017. Two independent reviewers completed preliminary and full-text screening of all articles. English-language studies reporting on DRM use in patients with full-thickness burn injury were included. A single reviewer completed data extraction for qualitative analysis. The literature search generated 914 unique articles, of which 203 articles were reviewed and 72 met inclusion criteria for qualitative analysis. The DRM was applied to 1084 patients (74% for acute burns, 26% for burn reconstruction) mainly from North America and Europe. The following outcomes were assessed: scar appearance and cosmesis, range of motion (ROM), reported morbidity, as well as safety and efficacy. Of the twelve studies that described changes in ROM, 4 used objective tools and 8 used subjective measures of post-operative ROM. There was significant improvement in 95% of reconstructive patients. One study reported no or limited improvement in 15.7% of DRM-treated sites. The most frequently treated reconstructive sites were the neck, hand/wrist, lower extremity, and axilla. Vancouver scar scale was used in 8 studies (2 RCTs) and indicated a significant improvement of the scar quality with DRM use. The overall complication rate was 13.3%, most commonly infection, graft loss, hematoma formation, and contracture. While variability in reported functional and cosmetic outcomes was observed, DRM demonstrates improvements in ROM and scar appearance with no objective regression reported. Essential demographic data (gender, age) was lacking in more than a third of the studies and the level of evidence amongst studies was low overall, despite 4 RCTs. Standardization in reporting outcomes in burns following application of dermal substitutes should be considered for future studies. Overall, DRM is safe for use in acute burn surgery and burn reconstruction. Aids in surgical decision making for patients with full-thickness burn injury.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.021 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.007 | 0.007 |
| Bibliometrics | 0.009 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".