Dermal regeneration template for deep hand burns: clinical utility for both early grafting and reconstructive surgery

doi:10.1016/S0007-1226(03)00366-7

British Journal of Plastic Surgery

Volume 56, Issue 8, December 2003, Pages 764-774

https://doi.org/10.1016/S0007-1226(03)00366-7 Get rights and content

Abstract

Adequate acute treatment of the deeply burned hand and any subsequent reconstructive procedures may be hampered by the lack of sufficient suitable graft material and the risks of donor site morbidity and scarring. This investigation was designed to determine the feasibility of treating deep hand burns using a dermal regeneration template. Patients with deep hand burns underwent either acute treatment or reconstructive procedures with Integra^® dermal regeneration template. Wound sites were first grafted with the dermal regeneration template, and then 2–3 weeks later after neodermis formation the silicone layer of the Integra was removed and a very thin split-thickness epidermal autograft placed. Acute grafting was performed on 15 hands in 11 patients and reconstructive surgery on 14 hands in 11 patients. Median follow-up was 12 months. Integra take was 100% on all treated hands. After acute grafting the wound site skin was flexible and supple and did not adhere to the deeper layers, thus permitting free articular and functional movement. Cosmetic results of acute surgery were judged satisfactory by both patients and surgeons. After reconstructive procedures, significant improvements were achieved in cosmetic status, based on Vancouver Scar Scale (p=0.0002), and in three measures of function, namely, thumb opposition score (p=0.0005), fingertip-to-palm distance (p=0.0039) and prehensile score (p=0.0039). Favourable cosmetic and functional outcomes were consistently attained using a synthetic dermal regeneration template for treatment of deep hand burns either by acute grafting or reconstructive surgery.

Section snippets

Patients

Between February 1997 and July 2002, Integra dermal regeneration template was used to treat 22 patients for deep burn injuries of the hand. Patients were eligible for the study if they presented with either acute 3rd-degree deep burns of the hand requiring prompt surgical excision and grafting or hypertrophic scars, contractures or adherent grafts on the hand necessitating reconstructive procedures with full- or split-thickness grafts. Candidates for acute treatment were excluded if they were

Acute surgery patients

Eleven patients with acute 3rd-degree burns, (eight men and three women) were treated with Integra on a total of 15 hands. Fourteen grafts were to the dorsum and one to the palmar region. Patient characteristics, TBSA burned, number of hands grafted, and time from injury to surgery are presented in Table 3. The median age of the patients was 52 years (range 18–73 years), with a median TBSA of 40% (range 1–60). Excision and grafting were performed on day two or three after the burn injury,

Discussion

This series of 22 patients is the first to focus on the cosmetic and functional results with Integra dermal regeneration template for the surgical treatment of deep burns of the hands either at the acute injury stage (15 hands) or during reconstructive procedures (14 hands). Though preliminary, the study results are promising.

In the acute surgery patients, compared with movement regained after full thickness grafting, the surgical team judged the outcomes achieved with the Integra to be

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Dermal regeneration template for deep hand burns: clinical utility for both early grafting and reconstructive surgery

Abstract

Section snippets

Patients

Acute surgery patients

Discussion

Burns

Hand Clin

Burns

Br J Plast Surg

Ann Chir Main

Clin Plast Surg

Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury

Ann Surg

Artificial dermis for major burns. A multicenter randomized clinical trial

Ann Surg