Hypertrophic scarring following burn injuries is a great concern for patients with deep burn injuries [1]. Raised scars may cause significant functional and cosmetic impairments including pain, which are responsible for a decreased quality of life [2, 3]. The incidence of scars is over 70% following burns and 40% of these are hypertrophic [4]. Using skin grafts and flaps in the reconstruction of movement function is one method to treat postburn hypertrophic scars. Artificial dermis is a new modality to solve this problem, especially in patients with large areas of full thickness burn wounds and who do not have sufficient healthy skin for donor site skin grafts [5].
One type of artificial dermis (Pelnac, Gunze Co, Kyoto, Japan) is composed of an outer silicone layer and inner porcine atelocollagen sponge layer. After the implantation of this artificial dermis on a wound, fibroblasts start to infiltrate into the inner collagen pores and new capillaries are formed within 2 to 3 weeks [6]. The new dermal layer (neodermis) is formed with an extracellular matrix, while the outer silicone layer can be removed (after 2 to 3 weeks). This is then followed by ultrathin split thickness skin graft implantation (approximately 0.15 mm in depth) on top of the neodermal layer. The limited donor site can be harvested many times within a shorter period compared with a regular split thickness skin graft (approximately 0.3 mm in depth) because the harvested split thickness skin graft is ultrathin. This artificial dermis is useful to surgeons for their procedures in improving hypertrophic scars. In this case report, we describe our experience in the correction of scar contracture using an artificial dermis (porcine collagen sponge) in a postburn patient with hypertrophic scarring.
A 20-year-old Thai man had postburn injuries to70% of his total body surface area incurred 2 years previously. There were lesions on his face, arms, trunk, and left leg. He also developed severe scar
contractures on his left arm and had an open wound that was approximately 3 × 3 centimeters on his elbow over the joint. The extensive scarring resulted in difficulty in movement and flexibility of his elbow joint (
After the artificial dermis was applied onto the wound and stapled to the edges (
The patient provided his written informed consent for publication of this case report including the clinical photographs.
Scar contracture after bum injuries is challenging. There are several methods by which to prevent and treat hypertrophic scars including topical agents, steroid injections, pressure garments, and surgery. The proper treatment of severe scar contracture is by a surgical procedure to release the skin tension.
One type of artificial dermis (graft for dermal defect) is a bilayer composed of an inner sponge layer of atelocollagen and an outer layer of silicone. It can be used in acute burn treatment and reconstruction procedures, as a single layer in trauma cases, or on other skin loss areas after surgery for tumor or nevus removal. It is very effective in functional and cosmetic improvements [7-10] and postprocedure contracture defects are found to be insignificant [11]. For the present patient, the cosmetic and functional appearance on his left arm was improved. He demonstrated an almost full extension of his left elbow joint compared with before the surgery. We have shown that artificial dermis is beneficial for scar reconstruction; especially when patients have a large burn area and do not have sufficient healthy skin graft area for application to the wound after scar excision. Moreover, this artificial dermis was developed for use in various indications. Growth factor was loaded into the inner layer, which can accelerate chronic wound healing and prolong its stability [12, 13]. The artificial dermis is impregnated with an antibiotic for application on contaminated wounds [14].
The use of an artificial dermis is effective in surgery for scar contracture. It is an alternative modality in solving scar problems; especially on large areas of burn injuries with a lack of sites for skin graft for wound coverage after scar excision.