Post-burn cervical keloid treatment with surgical excision and reconstruction with a dermal substitute and split thickness skin graft

Objectives:
	Facial burns can lead to horrible sequelae. In this regard, keloids represent a difficult challenge for any physician. No single therapeutic modality alone has proven effective although surgical excision is frequently the mainstay of therapeutic protocols. Keloids are very resistant to treatment and have very high recurrence rates. We present a case report of a patient undergoing marginal extra-lesional excision of a massive cervical keloid (post-burn) associated with recurrent infections and a reconstructive strategy using a dermal substitute and subsequent skin graft.

Methods:
	A two-stage approach was followed. Keloid was completely excised down to normal subcutaneous tissue. Dexamethasone was instilled at the wound bed. A bilayer dermal regeneration matrix was applied to the entire wound . This was covered with a “tie-over” dressing with paraffin gauze and octenidine.
	The second stage occurred 21 days later. The silicone sheet was removed and a split thickness skin graft was harvested from the anterior thigh using an electric dermatome and applied to the neo-dermis. A thight dressing was made with paraffin gauze and octenidine and the first dressing change was 5 days later. The patient used na elastic collar for the neck for post surgical elastic compression.

Results:
	Very good graft intake. Healing was uneventful and donor site morbidity was minimal without keloid formation. There were no signs of infection. The result was aesthetically acceptable and the patient was happy.
	No evidence of recurrence 20 weeks post-operative.

Conclusion:
	The combination of slip thickness skin graft with a dermal regenerative template seems to be very effective. It maintains the pliability of the skin with good cosmetic appearance, limiting skin creep. The removal of the dermis and a substantial amount of extracellular matrix components limits contracture, contributing to a tension-free healing. No recurrence was noted despite the short follow-up.