Reconstruction of Burn Scar of the Upper Extremities with Artificial Skin

Abstract

The management of upper-extremity burn contractures is a major challenge for plastic surgeons. After approval by the Food and Drug Administration, artificial skin (Integra) has been available in Taiwan since 1997. From January of 1997 to July of 1999, the authors applied artificial skin to 13 severely burned patients for the reconstruction of their upper extremities, resulting in an increased range of motion in the upper-extremity joints and improved skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a good appearance and pliable skin were obtained according to the Vancouver Scar Scale. According to this evaluation of Oriental skin turgor, normal pigmentation was restored about 6 months after the resurfacing procedure. For patients with severe burns in whom there is insufficient available skin for a full-thickness skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificial skin are (1) a 10- to 14-day waiting period for maturation of the neo-dermis, necessitating a two-stage operation, and (2) prevention of infection with antibiotics and meticulous wound care.

Development of New Reconstructive Techniques: Use of Integra in Combination with Fibrin Glue and Negative-Pressure Therapy for Reconstruction of Acute and Chronic Wounds

“…Integra (Johnson and Johnson, Hamburg, Germany) is a totally artificial material that is acellular and is composed of two skin-like layers. [3][4][5] The upper layer of the Silastic sheet is an epidermis-like structure, which controls water loss and prevents the invasion of microbes. The lower layer has a porous structure (pore size, 20 to 125 m), is composed of a cross-linked coprecipitate of bovine collagen and chondroitin-6-sulfate, and functions mainly as a template for dermal regeneration.…”

“…3 Several studies demonstrated good aesthetic and functional results in burn treatment and reconstruction; however, those studies also delineated the problems of the Integra take rate and the long interval between the surgical interventions. [3][4][5][6][7][8][9] In this study, we wanted to determine whether the Integra take rate could be improved with the use of fibrin glue (Tissucol, Baxter Deutschland GmbH, Heidelberg, Germany) and whether the interval of 21 days could be shortened with the use of negativepressure therapy (KCI, San Antonio, Texas).…”

Integra® jenseits des akuten Verbrennungstraumas im Kindesalter - Erfahrungen aus 5 Jahren -

“…Entfernung der Silikonfolie ein ideales Bett für dünne Spalthaut, sodass mit deren Einheilung ein weitgehend intaktes Integument resultiert. Die positiven Erfahrungen mit Integra in der Akutversorgung von thermisch verletzten Patienten führten zu einer breiten Anwendung weltweit [2,5,8,10]. Für Anwendungen im Kindesalter konnten wir vergleichsweise früh Indikationen ausloten [9], die in einem verstärkten Einsatz bei Rekonstruktionen im Kindesalter mün-deten.…”

“…Sowohl in der Akutversorgung als auch in der rekonstruktiven Chirurgie werden kaum neuerliche Narbenhypertrophien beschrieben [2,5,9]. Hier kommt die exzellente Qualität der Neodermis mit der Möglichkeit einer erfolgreichen Transplantation dünner und (wo möglich) ungemeshter Spalthaut zum Tragen.…”

Operatives Management und Nachsorge freier Spalthauttransplantate in der okuloplastischen Chirurgie

“…Han et al berichteten anhand von 38 Patienten mit Basalzellkarzinomen im Gesichtsbereich im Journal of Craniofacial Surgery 2012 über die Anwendung von Spalthauttransplantaten [7]. Wesentliche Vorteile des dort verwendeten Verfahrens sehen die Autoren im transplantierten autologen Epidermisanteil, der den Wunddefekt sofort bedeckt und die schnelle Migration und Proliferation anhängender epidermaler Zellen sowie von Melanozyten ermöglicht [13][14][15][16]. Zusammenfassend lässt sich feststellen, dass die okuloplastische Chirurgie von einigen Besonderheiten u. a. dünnste Oberflächen-haut gekennzeichnet ist.…”