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Caveats and Technique for the Reconstruction of Burns Contractures using an Artificial Dermis in a Tropical Burns Centre

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Objectives: Excision of scar tissue and locoregional flap coverage is the gold-standard in treating hypertrophic scarring and contractures from burns injuries. An artificial dermis with a split-thickness skin graft (STSG) is a viable alternative when donor sites are lacking in patients with extensive burns. There is a paucity of data on the use of dermal substitutes in a tropical burns centre, a practise frequently complicated by a high infection rate in the Southeast-Asian region. Moreover, the high cost of these dermal substitutes demands a successful outcome. We describe our successful ex- perience with the use of a bi-layered artificial dermis (Pelnac) and thin STSG in treating post-burns hypertrophic scars and scar contractures. Methods: A two-staged procedure comprising artificial dermis followed by a 9:1000th inch STSG was used to reconstruct full thickness wounds after the excision of burns contractures in 5 patients. These were located over three wrists, two ankles, one elbow, three necks, one chin, and one ear auricle. Cause of burns were flame burns in four and chemical burns in 1. Results There was a 100% rate of skin graft take over the wound beds which were covered with a neo- dermis 14-23 days after Pelnac was applied. One wound (9%) developed hypertrophic scarring around its border but the rest healed with a soft, pliable consistency and satisfactory cosmetic out- come. Patients achieved full range of motion when treated scars were located over joints. No in- fective complications were encountered. At 6 months, keloid scarring had recurred in the wound of a second patient. Secondary contraction occurred in 2 (18%) wounds although the consistency of the skin remained soft. Through this experience, we developed a reproducible, effective technique for the procedure. Conclusion: ! We demonstrate that a bi-layered artificial dermis with STSG may be used reliably in a tropical burns centre, whereby a consistent technique contributes greatly to its success.

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© Copyright 2020 Morressier GmbH.
All rights reserved.