Grafting of deeply burned problem zones in the lower extremity with a dermal substitute

Abstract 

Functional results after deep excision and split thickness skin grafts are often limited as a consequence of unstable grafted areas and contractures. In two patients with a full-thickness thermal injury to the lower extremities and one patient with a chronic unstable skin area over the knee, the Integra^TM bilayered membrane dermal substitute was applied. After uneventful dressing changes graft take was complete without infection or other complications. Complete wound closure was achieved in all three patients within 3–4 weeks after the initial operation. The functional range of motion of the involved joints and the skin quality and contour was superior to conventional grafted skin after excision down to fascia and rather more comparable to skin grafts over a tangentially excised eschar. After wound healing, the neodermis was histologically similar to normal dermis. Considering the high incidence of unstable skin and contractures after regular grafting of deeply excised burns, this concept may present a significant improvement not only for the primary but also for secondary reconstructive procedures, with respect to the long-term quality of life for burn patients.