Treatment Of Burn Scar Contracture Research Articles

A case-control study evaluating single and dual layer dermal matrix in treating scar contractures using the Vancouver and POSAS scar scales, and correlations with retraction and function in treating scar contractures

IntroductionThe dermal matrix appeared in the late 1990s and became an important tool in burn treatment. Following its success, new matrices soon emerged and were employed to treat burn contracture, but few studies have compared the different types available. This study evaluated two different dermal regeneration matrices comprised of one (Matriderm) or two layers (Integra) according to the Vancouver and the Patient and Observer Scar Assessment (POSAS) evaluation scales with regard to treatment of burn scar contracture. MethodsIn this prospective, case-control study, 24 patients with impaired mobility secondary to burns were divided into two groups and treated with dual or single layer matrices. Data were collected for intraoperative and postoperative complications, percentage take for matrix and graft areas, Vancouver scar scale score, POSAS score for skin quality assessment, area of matrix take, and skin graft take, and degree of mobility. Results and conclusionBoth matrices produced significant improvement according to the Vancouver and POSAS assessments over 12 months, but the dual layer matrix yielded better results than the single layer matrix in terms of retraction of the grafted area at 12 months, functional improvement, and skin quality as measured by the Vancouver and POSAS scales. According to statistical analysis, with p<0.05.

Prevention and Treatment of Burn Scar Contracture: A Practical Review.

Burn contracture affects close to one-third of all burn patients, leading to significant functional impairment and costs. Effective prevention and treatment strategies are necessary to decrease morbidity and unnecessary costs. This scoping review aimed to summarize prevention and treatment strategies used for management of burn scar contractures published in the literature since 2000. A comprehensive PubMed review was performed in October 2022 to identify methods of burn contracture prevention and treatments. Non-English, duplicate, and unavailable articles were excluded. Data were extracted including publication year, techniques, and outcomes. A total of 327 publications met criteria for inclusion. Most articles were published in 2011 (n = 22). Treatment strategies were discussed in 82.9% of studies, prevention in 16.5%, and both in 0.6%. The most common areas discussed included the upper extremity (n = 127) and neck (n = 102). Flaps were the most frequently used method (n = 208), followed by autografts (n = 89). Most preventative therapies were still in early stages of development. Burn contracture management requires a highly individualized approach with many available reconstructive techniques available. Further research is needed to improve prevention techniques and decrease morbidity and cost to patients.

A systematic review on burn scar contracture treatment: searching for evidence.

Treating burn scar contracture remains a challenging problem for reconstructive surgeons. At present, no consensus exists on when to use what kind of technique. Therefore, a systematic review was performed on the effectiveness of the different surgical techniques after burn scar contracture release. Electronic databases were searched using a predefined search strategy. Studies evaluating the outcome of surgical techniques for the treatment of burn scar contractures were included. The methodological quality was tested and the data were summarized. One thousand six hundred fourty-nine papers were identified of which 17 met the inclusion criteria. Three papers reported on a controlled trial, 14 were cohort studies, including 10 of a pre-post operative design and 4 of a comparative design. The papers described outcomes of grafts, flaps with random or defined vascularization, and dermal substitutes. All studies had methodological shortcomings and most used inappropriate statistical methods. The current evidence on the effectiveness of reconstruction techniques for burn scar contractures was summarized. Due to the scarcity and low quality of the included studies, no definitive conclusions could be reached about the effectiveness of different techniques. Therefore, no direct implications for daily practice could be made. However, recommendations could be given for improvement of the quality of further primary research on the effectiveness of surgical treatment strategies for burn scar contracture release.

Template for Skin Regeneration

Advances in critical care allowed survival of large total body surface burn patients in the 1970s, spawning the development of artificial skin for burn victims. Lack of dermis resulted in severe scarring and contractures. The physicochemical properties that are critical to dermal regeneration have subsequently been described, and a dermal regeneration template has been developed. The peer-reviewed literature regarding the basic science and clinical use of dermal regeneration template was reviewed, as was our practical experience in using dermal regeneration template. Dermal regeneration template has been effective in treating large areas of skin loss in burn victims and has been shown to have scar reductive and regenerative properties. Its use has been extended to reconstructive burns, including scar revisions and the treatment of burn scar contractures. It has also been useful in treating small areas of exposed bone, tendon, or joints and a variety of acute and chronic wounds. Meticulous wound bed preparation and close monitoring of the dermal regeneration template is critical to successful use. Dermal regeneration template provides a novel element to add to the reconstructive tools used today by plastic surgeons. Further development of these technologies may allow for improved regenerative capacity of these devices to allow optimal aesthetic and functional results of dermal reconstruction.

Skin Regeneration for Children With Burn Scar Contracture Using Autologous Cultured Dermal Substitutes and Superthin Auto-Skin Grafts

We have evaluated a novel treatment of burn scar contracture in children. This method involves the application of an autologous cultured dermal substitute (CDS), followed by a graft of superthin split-thickness skin. In the first operation, the autologous CDS was applied to the skin defect that had occurred after releasing the scar contracture. In the second operation, a superthin thickness skin graft (4 approximately 6/1000 inches) was applied 5 approximately 12 days after the first operation. The autologous CDS was applied to 10 sites of 5 children. On 8 sites, the skin grafts were contracted to some extent at an early stage. However, these skin grafts were stretched gradually to a range from 60% to 100% of an original size. At 2 sites, the skin grafts had stretched from 110% to 130% of the original size. This strategy may be useful for the treatment of burn scar contracture in children.

Surgical correction of burn scar contractures of the foot in children

The results of reconstructive procedures for the treatment of burn scar contractures of the feet in 55 children undergoing 90 operations were reviewed. The patients were treated in all but one case by release of the contracture band with placement of a skin graft in the resulting defect. There was an overall recurrence rate of 15 per cent that was not affected by the use of split-thickness versus full-thickness grafts. The time delay from the thermal injury to the reconstructive procedure was also found not to affect the outcome. Postoperative immobilization by the use of either a dynamic or an adynamic splint was found to be important both for preventing graft loss and for decreasing the rate of contracture recurrence.

The jump flap procedure in the treatment of burn scar contractures of the neck

Summary The advantages of jump flaps compared with tubed pedicles are discussed particularly in the treatment of extensive scar contractures of the neck in developing countries where free skin grafting techniques are unsuitable.