clinician survey of skin substitute use in burns care in the UK and Ireland: The CASSIUS study.

BACKGROUND: Skin substitutes are routinely used in burn surgery. Increasing numbers of marketed products, regional variation in use, and lack of high-quality research may be contributing to non-standardised care across units. Previous research has also shown that many healthcare professionals in burns care cannot correctly identify the constituents of skin substitute products, with medicolegal implications related to consent. METHODS: A cross-sectional survey of healthcare professionals across all burn units/centres in the UK and Ireland was conducted between 24/04/2022-15/08/2022. The survey was developed and distributed by the Reconstructive Surgery Trials Network using REDCap©. We evaluated current skin substitute use, clinicians' awareness of their constituents, factors influencing product selection, and feasibility of performing future randomised trials in this area. RESULTS: From all burn units and centres in the UK, 306 healthcare professionals responded. Knowledge of product constituents was significantly greater among senior burn surgeons, but <50% respondents correctly identified the constituents of most products. Skin substitutes were used by most units/centres for acute superficial partial burns (16/21, 76%), deep partial/full-thickness burns (18/21, 86%) and secondary reconstruction (20/21, 95%) but not for donor sites (6/21, 29%). Biobrane was the most used for superficial partial burns and Novosorb-BTM for acute deep partial/full-thickness burns and secondary burn reconstruction. Most respondents reported willingness to consider randomising patients to future trials involving skin substitutes. CONCLUSIONS: Skin substitute use is reportedly widespread, but there is significant intra- and inter-unit variability. Better evidence to guide use is required, ideally with randomised controlled trials comparing products. Knowledge of product constituents, particularly by non-senior burn surgeons, requires improvement.