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ISSN 1405-0625 (Print)

2023, Number 3

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Cir Plast 2023; 33 (3)

Upper limb reconstruction with regenerative dermal matrix after burn injury, experience in a referral center in northeastern Mexico

Chávez-Suárez MA, Beyuma-Mora HE, Treviño-García A, Meza-Martínez DA

Language: Spanish
References: 20
Page: 120-126
PDF size: 488.02 Kb.


ABSTRACT

Burn wounds are considered complex wounds, especially full-thickness ones, which require early debridement with subsequent coverage of the residual area, skin autograft being the choice in most cases. However, there are situations in which this is not an option, and other therapeutic modalities are indicated, either in the context of a patient with extensive burns and scarce graft donor areas, or deep burns which, after debridement, expose "critical areas" that are not candidates for coverage with skin grafts in the first stage or in the management of sequelae for functional and cosmetic improvement. Currently there are several alternatives, being dermal substitutes and among them, the regenerative dermal matrix, a valuable resource. We present a case with the application of this tool in the management of a patient with full-thickness burns, whose initial standard treatment through early debridement and application of skin grafts was not successful in both upper extremities, making reconstructive management through wide debridement and subsequent application of regenerative dermal matrix for three weeks (23 days) with formation of a viable neodermis necessary and finally, coverage with skin grafts. The result was a complete integration of the grafted areas seven days after they were placed as well as optimal functionality and aesthetics of the skin coverage in both upper extremities with a follow-up at six and twelve months.


REFERENCES

  1. Hicks KE, Huynh MNQ, Jeschke M, Malic C. Dermal regenerative matrix use in burn patients: a systematic review. J Plast Reconstr Aesthet Surg 2019; 72 (11): 1741-1751. doi: 10.1016/j.bjps.2019.07.021.

  2. Lagus H, Sarlomo-Rikala M, Bohling T, Vuola J. Prospective study on burns treated with Integra®, a cellulose sponge and split thickness skin graft. Burns 2013; 39 (8): 1577-1587. doi: 10.1016/j.burns.2013.04.023.

  3. Tomkins RG, Hilton JF, Burke JF, Schoenfeld DA, Hegarty MT, Bondoc CC et al. Increased survival after massive thermal injuries in adults. Crit Care Med 1989; 17 (8): 734-740. doi: 10.1097/00003246-198908000-00003.

  4. Cuadra A, Correa G, Roa R, Piñeros JL, Norambuena H, Searle S et al. Functional results of burned hands treated with Integra®. J Plast Reconstr Aesthet Surg 2012; 65 (2): 228-234. doi: 10.1016/j.bjps.2011.09.008.

  5. Peck MD, Kessler M, Meyer AA, Bonham Morris PA. A trial of the effectiveness of artificial dermis in the treatment of patients with burns greater than 45% total body surface area. J Trauma 2002; 52 (5): 971-978. doi: 10.1097/00005373-200205000-00024.

  6. Branski LK, Herndon DN, Pereira C, Mlcak RP, Celis MM, Lee JO, Sanford AP, Norbury WB, Zhang XJ, Jeschke MG. Longitudinal assessment of Integra in primary burn management: a randomized pediatric clinical trial1. Crit Care Med 2007; 35 (11): 2615-2623. doi: https://doi.org/10.1097/01.ccm.0000285991.36698.e2.

  7. Ríos M, Troncoso E, Alzate A, Arriagada C. Reconstrucción plantar con matriz de regeneración dérmica (Integra®) en paciente quemado eléctrico. Presentación de un caso y revisión de la literatura. Rev Chil Cirugía 2016; 69 (6): 489-494. doi: 10.1016/j.rchic.2016.11.010.

  8. Constant E, Burke JF. Successful use of a physiologically acceptable artificial skin in the treatment of extensive burn injury. Plast Reconstr Surg 1982; 70 (6): 784. doi: 10.1097/00006534-198212000-00008.

  9. Moiemen NS, Vlachou E, Staiano JJ, Thawy Y, Frame JD. Reconstructive surgery with Integra dermal regeneration template: histologic study, clinical evaluation, and current practice. Plas Reconstr Surg 2006; 117 (Suppl): 160S-174S. doi: 10.1097/01.prs.0000222609.40461.68.

  10. Malic C, Logsetty S, Papp A, Izadpanah A, Cheng H, Cooper MJ et al. The development of a treatment pathway for dermal regenerative matrix (DRM). Burns 2018; 44 (7): 1767-1774. doi: 10.1016/j.burns.2018.06.005.

  11. Sokolich JC, Jeng JC, Light TD, Jaskille AD, Street JH, Jordan MH. Seven years' experience with Integra® as a reconstructive tool. J Burn Care Res 2006; 27 (Suppl): S92. doi: 10.1097/01253092-200603001-00088.

  12. Wisser D, Steffes J. Skin replacement with a collagen based dermal substitute, autologous keratinocytes and fibroblasts in burn trauma. Burns 2003; 29 (4): 375-380. doi: 10.1016/s0305-4179(03)00013-5.

  13. Popescu S, Ghetu N, Grosu O, Nastasa M, Pieptu D. Integra- a therapeutic alternative in reconstructive surgery. Our first experience. Chirurgia (Bucur) 2007; 102 (2): 197-204.

  14. Lynch JB, Ismael TS, Kelly JL. Release of anterior neck burn contracture using artificial dermis and vacuum-assisted closure. Plast Reconstr Surg 2008; 121 (1): 352-353.

  15. Danin A, Georgesco G, Le Touze A, Penaud A, Quignon R, Zakine G. Assessment of burned hands reconstructed with Integra® by ultrasonography and elastometry. Burns 2012; 38 (7): 998-1004. doi: 10.1016/j.burns.2012.02.017.

  16. Klein MB, Engrav LH, Holmes JH, Friedrich JB, Costa BA, Honari S et al. Management of facial burns with a collagen/glycosaminoglycan skin substitute-prospective experience with 12 consecutive patients with large, deep facial burns. Burns 2005; 31 (3): 257-261. doi: 10.1016/j.burns.2004.11.013.

  17. Boyce ST, Kagan RJ, Meyer NA, Yakuboff KP, Warden GD. The 1999 clinical research award cultured skin substitutes combined with integra artificial skin1 to replace native skin autograft and allograft for the closure of excised full–thickness burns. J Burn Care Rehabil 1999; 20 (6): 453-461. doi: 10.1097/00004630-199920060-00006.

  18. Young RC, Burd A. Paediatric upper limb contracture release following burn injury. Burns 2004; 30 (7): 723-728. doi: 10.1016/j.burns.2004.03.017.

  19. Heimbach D, Luterman A, Burke J, Cram A, Herndon D, Hunt J et al. Artificial dermis for major burns. Ann Surg 1988; 208 (3): 313-320. doi: 10.1097/00000658-198809000-00008.

  20. Lee LF, Porch JV, Spenler W, Garner WL. Integra in lower extremity reconstruction after burn injury. Plast Reconstr Surg 2008; 121 (4): 1256-1262. doi: 10.1097/01.prs.0000304237.542.




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