503 Use of a Biodegradable Polyurethane Dermal Matrix to Treat a Facial Burn in a Patient with 90% TBSA Burns

Abstract

Full thickness facial burns should be treated in a way that honors the best possible outcomes for facial cosmesis and function. In patients with massive burns the options are limited. We present the case of a successful facial autograft using a biodegradable polyurethane matrix prior to graft application. An 11-year-old boy sustaining 90% TBSA full thickness burns after an ATV explosion was treated at our hospital. Spared areas included the left anticubital fossa, bilateral feet, pelvis, and scalp. Unfortunately, the entirety of his face sustained a full thickness burn injury in the accident. He underwent tangential excision of the majority of his burned surfaces in a series of operations that included using the same matrix. On post injury day 8 he had tangential excision of the facial burns with placement of allograft. Three days later, the facial allograft was removed and the biodegradable polyurethane dermal matrix was secured to the face. Ten weeks after placement, sheet autografts were placed over the face. At the time of the operation the matrix appeared salmon pink and adherent. The sheet autografts were applied horizontally across the face in accordance with aesthetic units. Donor sites were taken from several re-harvested areas (including scalp and lower abdomen). There was near 100% take of the facial autografts. With regard to esthetics, the resultant facial autograft appeared pink, healthy, well vascularized, and smooth. The patient had very appropriate facial contour and some functional facial expression. There are small areas of minor ectropion, however this is a common occurrence with facial autografts regardless of dermal substrates utilized. The biodegradable polyurethane dermal matrix is a relatively new product that is composed of three distinct layers, all of which are derived from polyurethane material. The foam layer contacts the wound and is highly porous, an adhesive layer bonds the foam to a sealing membrane which comprises the layer of the product that is exposed to the environment. Of note, the matrix did not desiccate, macerate, and seemed to resist infection. This was distinctly advantageous for our patient with extensive 90% TBSA burns and facilitated a long, but safe, time course between wound excision and definitive grafting. From this case, we observed that utilizing this biodegradable polyurethane dermal matrix as a dermal substrate for facial autografts was feasible, demonstrated excellent early cosmetic results, and also provided long term wound bed protection, and thus more flexibility, to optimize timing of autograft application.