Effectiveness of Thick Acellular Dermal Matrix (Allocover(R)) in Burn and Burn Scar Contracture

PURPOSE: To treat burn and burn scar contracture, many types of dermal substitutes have been manufactured and used recently. Allogenic dermis is known to have best cellular affinity to the host, but it is the thinnest product among artificial dermis. Processed thick allogenic dermis (Allocover(R)) has been developed and applied to overcome the problems of preexisting materials as a permanent dermal substitute. METHODS: From June 2007 to May 2009, we have grafted thick acellular human dermal allograft with thin split-thickness skin graft on burn wound and burn scar contracture of feet and legs in 14 patients who had hypertrophic scar, joint contracture and various skin defect areas. Intraoperatively, we fixed spilt thickness skin graft to artificial dermis with suture fixation for avoiding the mobilization between them. RESULTS: Thirteen patients out of 14 patients had no problem. One patient underwent partial skin loss and secondary healing process. During the 18 months of follow up period, no contracture recurrence or skin loss was observed. CONCLUSION: The thick acellular human dermal allograft (Allocover(R)) could be very useful in the management of skin loss and burn scar contractures. Its vascularization has occurred fast enough that wounds can be covered in an adequate layer of dermal augmentation with minimal contracture and good cosmetic results.

Reconstruction of Burn Scar Contracture with Split-Thickness Skin Graft Taken from the Scalp and Alloderm(R): Case Report

A 13 year old male patient had limitation of foot motion due to burn scar contracture on right ankle area. The scar contracture was released and Alloderm(R) was applied over the raw surface. Split thickness skin was harvested from the scalp and harvested skin was applied over Alloderm(R). Epithelialization of donor site began from the post-op 5th day. Graft was well taken without any problem. There was no complications during 6 months of follow-up period.

Island scapular flap based on transverse branch of circumflex scapular artery for axillary burn scar contracture / 中华医学美学美容杂志

Objective Island scapular flap (ISF) based on transverse branch of circumflex scapular artery is less reported than ISF based on ascending or descending branch. This article presented authors' experiences in correction of severe axillary burn scar contracture with ISF based transverse branch of circumflex scapular artery. Methods ISFs based transverse branch was harvested in 12 patients with 15 severe axillary burn scar contracture, rotating an arc of about 180°. Flap size was between 12 cm× 5cm to 20 cm × 10 cm. The donor site was closed primarily. Results All 15 flaps survived completely and axillary burn scar contracture was corrected successfully. 8 patients were satisfied with both the functional and aesthetic results after 1-3 years' follow-up. Conclusion ISF based transverse branch of circumflex scapular artery is a good choice for reconstruction of severe axillary burn scar contracture, especially for female patients or ones whose ISF based on ascending or descending branch could not be harvested because of formation of hypertrophic scar in donor site.

Acceleration of Integra Incorporation in Reconstruction of Burn Scar Contracture with the Vacuum-Assisted Closure(VAC)

PURPOSE: Negative pressure therapy has been used in various conditions to promote wound healing. It has also been used to secure a skin graft by improving microcirculation and improving tight adhesion between the graft and the recipient bed. To reduce post burn scar contracture and improve aesthetical result, many types of dermal substitutes have been invented and used widely. The goal of this study is to evaluate usefulness of the VAC(Kinetic concepts Inc., San Antonio, TX) in improving the take rate and time to incorporation of Integra(R) in reconstruction of burn scar contracture. METHODS: A retrospective study was performed from October, 2006 to December, 2008. The VAC was utilized for 11 patients. The patient's ages ranged from 5 to 27 with an average of 19.7 years. The surface area ranged from 24 to 1,600cm2 with an average of 785cm2. The burn scars were excised deep into normal subcutaneous tissue to achieve complete release of the scar, Integra(R) was sutured in place with skin staple and Steri-strip(R). Then slit incisions were made on silicone sheet only with No.11 blade for effective drainage. The VAC was used as a bolster dressing over Integra(R). Negative-Pressure ranging from 100 to 125mm Hg was applied to black polyurethane foam sponge trimmed to the appropriate wound size. An occlusive seal over the black polyurethane foam sponge was maintained by a combination of the occlusive dressing, OP-site(R). The VAC dressing changes were performed every 3 or 4 days until adequate incorporation was obtained. The neodermis appeared slightly yellow to orange color. When the Integra(R) deemed clinically incorporated, The VAC was removed and take was estimated with visual inspection. Very thin STSG(0.006-0.008 inches) was performed after silicone sheet removal. RESULT: The mean time for clinically assessed incorporation of Integra(R) was 10.00 days(range 9-12). The mean dressing change was 3.5 times until take was obtained. In All patients, Integra(R) had successful incorporation in tissue without serious complications. CONCLUSION: Integra(R) in combination with Vacuum- Assisted Closure(VAC) may be incorporated earlier than conventional dressing method.

Correction of Burn Scar Contracture: Indication and Choice of Free Flap

PURPOSE: Most burn scar contractures are curable with skin grafts, but free flaps may be needed in some cases. Due to the adjacent tissue scarring, local flap is rarely used, and thus we may consider free flap which gives us more options than local flap. However, inappropriate performance of free flap may lead to unsatisfactory results despite technical complexity and enormous amount of effort. The author will discuss the points we should consider when using free flaps in treating burn scar contractures METHODS: We surveyed patients who underwent free flaps to correct burn scar contractures from 2000 to 2007. We divided patients into two groups. The first group was those in which free flaps were inevitable due to exposure of deep structures such as bones and tendons. The second group was those in which free flap was used to minimize scar contracture and to achieve aesthetic result. RESULTS: We performed 44 free flap on 42 patients. All of the flaps were taken well except one case of partial necrosis and wound dehiscence. Forearm free flap was the most common with 21 cases. Most of the cases(28 cases) in which free flaps were inevitable were on the wrist and lower limbs. These were cases of soft tissue defect due to wide and extensive burns. Free flaps were done in 16 cases to minimize scar contracture and to obtain aesthetic outcome, recipient sites were mostly face and upper extremities. CONCLUSION: When using free flaps for correction of burn scar contractures, proper release and full resurfacing of the contracture should be carried out in advance. If inadequate free flap is performed, secondary correction is more challenging than in skin grafts. In order to optimize the result of reconstruction, flap thickness, size and scar of the recipient site should be considered, then we can achieve natural shape, and minimize additional correction.

Preserved Superficial Fat Skin Composite Graft for Correction of Burn Scar Contracture of Hand

PURPOSE: Split or full thickness skin graft is generally used to reconstruct the palmar skin and soft tissue defect after release of burn scar flexion contracture of hand. As a way to overcome and improve aesthetic and functional problems, the authors used the preserved superficial fat skin(PSFS) composite graft for correction of burn scar contracture of hand. METHODS: From December of 2001 to July of 2007, thirty patients with burn scar contracture of hand were corrected. The palmar skin and soft tissue defect after release of burn scar contracture was reconstructed with the PSFS composite graft harvested from medial foot or below lateral and medial malleolus, with a preserved superficial fat layer. To promote take of the PSFS composite graft, a foam and polyurethane film dressing was used to maintain the moisture environment and Kirschner wire was inserted for immobilization. Before and after the surgery, a range of motion was measured by graduator. Using a chromameter, skin color difference between the PSFS composite graft and surrounding normal skin was measured and compared with full thickness skin graft from groin. RESULTS: In all cases, the PSFS composite graft was well taken without necrosis, although the graft was as big as 330mm2(mean 150mm2). Contracture of hand was completely corrected without recurrence. The PSFS composite graft showed more correlations and harmonies with surrounding normal skin and less pigmentation than full thickness skin graft. Donor site scar was also obscure. CONCLUSION: The PSFS composite graft should be considered as a useful option for correction of burn scar flexion contracture of hand.

Management of the Hyperplastic Scar and Contracture after Burn(review) / 中国康复理论与实践

@#Hyperplastic scar and contracture are two mainly respects that contribute to poor functional recovery of the patients after burn.The principles of prevention and management of the scar were reviewed in the article and the methods in facilitating functional recovery were also discussed as well.

Repairing burn scar contracture of chin and neck with cervico-scapulo-dorsal reverse axial flap in children / 中华医学美学美容杂志

Objective To explore an effective method in reconstructing of burn scar contracture of the chin and neck in children. Methods The blood in the transverse cervical artery might flow reverse into the suprascapular artery and the posterior intercostals perforators through anastomic branches. An axial skin flap in the cervico-scapulo-dorsal area could be adequately supplied by this artery, and we had therefore used this flap to repair burn scar in the neck. Results 30 cases obtained satisfactory clinical results with this flap. The follow-up for two years in 18 patients showed that the neck of the patients moved about freely, and the develpment of the chin was not influenced, and the color of flaps was fine. Conclusion The blood supply of the flap is reliable and stable. So it is a very useful method in reconstructing the burn scar of the chin-neck in children.

Aesthetic and Functional Reconstruction of the Postburn Contracture in the Lower Face and Neck Area using Free Radial Forearm Flap

Often, the burn injury has produced deformities both of the facial contour and the facial cover. The hypertrophic burn scar contracture of the lower face and neck is problematic because it distress the patients, functionally and esthetically. In the correction of the lower face and neck deformities, we should focus our attention not only on the restoration of the normal form and function, but also on the achievement of more beautiful appearance. When there was no available skin adjacent to the deformed area, we reconstructed the deformities with free radial forearm flap. So we can restore the deformed face to near normal shape and get good skin quality with these flaps. There were no remarkable complications after surgeory in all cases. To get better outcome of surgery, we have to consider some points. 1) The release and resurfacing of the neck contracture should be carried out in advance. 2) The lowest margin of the flap should be limited, to at least one-finger breadth above the hyoid bone because low setting of the flap deteriorates the cervicomental angle. 3) Adhesion between the flap dermis and the defect bed may be necessary for reconstruction of dumbbell shaped lower lip subunit. Flaps did not look completely normal, but those were compatible with adjacent skin. We could have an adequate functional resurfacing and optimal esthetic outcomes while minimizing recurrent contracture.