EARLY WOUND CLOSURE AND EARLY RECONSTRUCTION - EXPERIENCE WITH A DERMAL SUBSTITUTE IN A CHILD WITH 60 PER CENT SURFACE-AREA BURN

A dermal substitute was used for wound management and after early scar release on a 4-year-old child with mostly full thickness bums coverin g 60 per cent of the body surface. The biosynthetic material (INTEGRA( TM) Artificial Skirt) consists of an upper silicone film and a lower l ayer of porous cross-linked collagen nad chondroitin-6-sulfate as a te mplate for dermal regeneration. Eight sheets each 4 x 10 in. were used to cover the patient's whole trunk after staged tangential necrectomy . In the third and fourth weeks following application the silicone lay er was easily removed and the newly formed dermis covered with widely meshed, thin split-thickness autograft. Seven weeks after admission an early neck contracture was released and the skill defect also coveted with INTEGRA(TM) Artificial Skin. Following the same principle, trans plantation of the thin unmeshed autograft was performed successfully 3 weeks later. The good results regarding handling final take, apparent initial scar reduction, and early recovery may favourably effect init ial treatment and reconstruction planning after extensive full-thickne ss burn injuries. (C) 1997 Elsevier Science Ltd for ISBI.