Combined AlloDerm ® and thin skin grafting for the treatment of postburn dyspigmented scar contracture of the upper extremity

Abstract

Postburn dyspigmented scar contractures of the upper extremity often require aesthetic improvement. The ideal reconstruction of this deformity remains a challenge because the various available skin grafts and flaps result in skin colour mismatches, prominent marginal scars and donor morbidity. Postburn scar contractures and dyspigmented areas of the upper extremity can be improved by a combination of dermabrasion and Alloderm(®) graft over scar-releasing defect. Their raw surfaces are subsequently re-surfaced with thin split-thickness skin graft (0.005-0007 inches thick). Twenty-seven patients with wide dyspigmented scar contractures of the upper extremity underwent the combined techniques described by us. The median patient age at burn incidents was 3 years and at operation was 24 years. Median thin skin graft area was 180cm(2), and the median AlloDerm(®) graft area was 40cm(2). Thin skin and AlloDerm(®) grafts took root completely in all patients without re-grafting. Follow-up periods ranged from 30 to 67 months (average 47.6 months). Re-pigmentation was achieved in all cases and all scar contractures were adequately released and treated with an AlloDerm(®) graft. Paired differences between preoperative and postoperative parameters as determined by the Vancouver Scar Scale (VSS) were significant. Focal hypertrophic scar and reddish-coloured graft sites gradually improved over 3-4 years postoperatively. Graft margin and donor scars were inconspicuous. Our described combined technique was found to treat these deformities effectively. We suggest that the use of Alloderm(®) and thin skin grafting be considered in patients concerned about this type of cosmetic disfigurement.