Severe Multiple Extensive Postburn Contractures: A Simultaneous Approach With Total Scar Tissue Excision and Resurfacing With Dermal Regeneration Template

Abstract

Deep partial or full-thickness burns if untreated, neglected, or managed conservatively can develop dysfunctional scar contractures with severe deformities and significant reduction in patient's activities of daily life. These burn sequelae can require multistage procedures to restore anatomy and function. These include single scar release, use of skin grafts, skin expansion, regional or free musculocutaneous or fasciocutaneous flaps to achieve adequate functional improvement. The use of dermal regeneration template (Integra), initially used in primary burns reconstruction, has been already described and compared in single scar contracture-releasing procedures, but to our knowledge, it has not been used in the simultaneous releasing of multiple severe extensive postburn contractures. A simultaneous approach with total scar tissue excision and resurfacing with Integra may reduce the number of operations and the prolonged time period of treatment required by conventional procedures of multistage scar contracture release. A 7-year-old girl, who developed severe postburn scar contractures involving the right upper limb, right axilla, neck, and face after healing of a deep 16% total body surface area burn injury, was treated with this approach. Restoration of anatomy and function, with significant improvement in the range of movement of the involved regions, was achieved in a relatively short period of time (15 weeks) with limited donor-site morbidity and preservation of donor areas for possible future procedures. Total scar tissue excision and resurfacing with Integra should be considered as a valid option in case of simultaneous management of severe multiple extensive scar contractures.