Reconstruction of burn scar of the upper extremities with artificial skin

The management of upper-extremity burn contractures is a major challenge fo r plastic surgeons. After approval by the Food and Drug Administration, art ificial skin (Integra) has been available in Taiwan since 1997. From Januar y of 1997 to July of 1999, the authors applied artificial skin to 13 severe ly burned patients for the reconstruction of their upper extremities, resul ting in an increased range of motion in the upper-extremity joints and impr oved skin quality. An additional benefit was the rapid reepithelialization of the donor sites. There were no complications of infection throughout the therapeutic course, and the overall results were satisfactory. During the 2-year study, scar condition was monitored between 8 and 24 months, and a g ood appearance and pliable skin were obtained according to the Vancouver Sc ar Scale. According to this evaluation of Oriental skin turgor, normal pigm entation was restored about 6 months after the resurfacing procedure. For p atients with severe burns in whom there is insufficient available skin for a full-thickness skin graft or another appropriate flap for scar revision, Integra is an alternative. The two major concerns in dealing with artificia l skin are (1) a 10- to 14-day waiting period for maturation of the neo-der mis, necessitating a two-stage operation, and (2) prevention of infection w ith antibiotics and meticulous wound care.