A classic algorithm for covering deep defects with exposed bone, muscle or tendon in acute reconstructive surgery is use of: DIRECT SUTURE - FULL-THICKNESS AUTOGRAFT - LOCAL FLAP - EXPANDER - DISTANT FLAP - FREE FLAP. With the arrival of dermal regenerative templates, there is a change in the classical algorithmic ladder, where dermal replacement opens up new possibilities for covering large deep defects with the consequent creation of a high quality skin cover. The use of a negative pressure wound therapy (NPWT) for pre-treatment is appropriate in the preparation of wound bed.

The poster presents the course of solving a complicated deep defect with exposed bone by a single-layer dermal substitute in a 68-year-old patient with a history of colorectal carcinoma, haemicolectomy with stoma, partial resection of liver for metastasis, post actinotherapy, with hypertension and II.type diabetes mellitus, chronic smoker bronchitis.

The patient was admitted to Prague Burn centre with a flame burn of 50%BSA IIb-IIIgr., injured in a suicidal attempt. Burned areas were treated with multiple necrectomy and split thickness dermoepidermal autografting. A defect with exposed bone and non-vital periosteum formed in the area of the ventral tibia. After non-vital periosteum resection (size about 15x3.5cm) the defect was resolved using a negative pressure wound therapy system for 20 days, and after formation of granulation tissue on the wound bed, a single layer dermal substitute, dermoepidermal split-thickness autograft and NPWT system were applied at one time. Treatment resulted in a fully healed area with high-quality skin cover.

RESULT: The use of dermal regenerative template can change the classic ladder of treatment of acute deep defect in problematic area and an complicated healing process.

2 - The use of Single Layer Dermal substitute in cover of post burn deep defect with exposed bone (case report).