Grafting of deeply burned problem zones in the lower extremity with a dermal substitute

Functional results after deep excision and split thickness skin grafts are often limited as a consequence of unstable grafted areas and contractures. In two patients with a full-thickness thermal injury to the lower extremiti es and one patient with a chronic unstable skin area over the knee, the Int egra(TM) bilayered membrane dermal substitute was applied. After uneventful dressing changes graft take was complete without infection or other compli cations. Complete wound closure was achieved in all three patients within 3 -4 weeks after the initial operation. The functional range of motion of the involved joints and the skin quality and contour was superior to conventio nal grafted skin after excision down to fascia and rather more comparable t o skin grafts over a tangentially excised eschar. After wound healing, the neodermis was histologically similar to normal dermis, Considering the high incidence of unstable skin and contractures after regular grafting of deep ly excised burns, this concept may present a significant improvement not on ly for the primary but also for secondary reconstructive procedures, with r espect to the long-term quality of life for burn patients.