The process of healing is especially important after burns of the upper extremities. In spite of timely and thorough primary and surgical care, the result is often unpleasant in the case of deep burns and appears in scar formation and skin contractures.Treatment is conservative, followed by surgical management. When performing surgical procedures, the concept of a progressive climb from simple to complex starting on the lowest rung and moving up until a suitable technique is arrived at, should be used.
In recent years, a number of dermal substitutes have been emerging, which are already part of the reconstructive ladder. Most of them are used individually, and some of them can be used in combination with partial skin grafts to improve the properties of the skin. In the previous 2 years we treated 10 patients with contractures of upper extremities, using acellular dermal matrix in order to restore the quality of skin. In all cases, the graft adhered completely. All 10 patients had better skin laxity after surgery and better mobility. We also documented thicker and more mobile dermis compared to non-surgical area of scarring tissue. The presented cases illustrate one of the possibilities in which skin substitutes combined with skin grafts are used to improve post burn scarring and mobility as well as better aesthetic and functional outcome.

6 - Use of acellular dermal substitute in treatment of skin contractures after burn injury – case presentation