Ann Surg Treat Res.  2014 Nov;87(5):253-259. 10.4174/astr.2014.87.5.253.

Management of neck contractures by single-stage dermal substitutes and skin grafting in extensive burn patients

• Seo DK
• Kym D
• Hur J

• KMID: 2266884
• DOI: http://doi.org/10.4174/astr.2014.87.5.253

Abstract

PURPOSE
Severe neck contracture is a problem that must be resolved by priority. We consider the best contracture treatment to be the full-thickness skin graft. However, clinicians often encounter patients, especially extensive burn patients, who have insufficient donor sites for the full-thickness skin graft. We treated extensive burn patients with neck scar contractures with a split-thickness skin graft (STSG) combined with dermal substitutes. The purpose of this study was to evaluate clinical outcomes of neck contracture treatment in extensive burn patients performing STSG with dermal substitutes as adjuvant treatment.
METHODS
We analyzed the retrospective clinical and photographic records of 28 patients with severe neck contracture who were admitted to Hallym University Hangang Sacred Heart Hospital, Seoul, Korea, from January 2012 to December 2012. We performed STSG in combination with dermal substitutes to minimize the degree of contracture.
RESULTS
The overall take rate of skin to dermal substitutes was 95.9%, and no grafts failed to affect recontracture except in one patient with a partial loss of artificial dermis who underwent a follow-up skin graft without any problems. Excellent/good outcomes were shown in 27 out of 28 patients.
CONCLUSION
In extensive burn patients, skin grafting in combination with dermal substitutes can be an alternative to STSG alone for contracture release.

Keyword

Neck contracture; Dermal substitutes; Reconstruction; Burn

MeSH Terms

Burns*
Cicatrix
Contracture*
Dermis
Follow-Up Studies
Heart
Humans
Korea
Neck*
Retrospective Studies
Seoul
Skin
Skin Transplantation*
Tissue Donors
Transplants

Figure

• 

  Fig. 1 (A) Preoperative image showing the split-thickness skin graft (STSG) with AlloDerm of a 39-year-old female with 73% total body surface area (TBSA) burned. Images of 3 days later (B) and 3 months later (C) after the STSG with AlloDerm of a 39-year-old female with 73% TBSA burned.

• 

  Fig. 2 (A) Preoperative image showing the split-thickness skin graft (STSG) with Matriderm of a 20-year-old man with 43% total body surface area (TBSA) burned. Images of 3 days later (B) and 1 year later (C) after the STSG with Matriderm of a 20-year-old man with 43% TBSA burned.

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