Annales de chirurgie plastique et esthétique
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Ann Chir Plast Esthet · Oct 2011
Review[Role of skin substitutes in surgical repair of the sequelae of burn injuries].
The therapeutic management of the sequelae of deep burns always relies in principle on dermal-epidermal grafts. The latter, the price of which to pay is heavy scarring, cannot always be performed because the surface of skin available may not be sufficient. Research pathways have turned towards the creation of skin substitutes to minimise the scarring and improve the cosmetic quality of the grafts. We review the technical characteristics of collagen matrixes (Intégra(®) - Matriderm(®)) and their method of use.
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The skin expansion marks a turning point in the repair of burn sequelae by allowing replace the original tissue with a coating of the same quality or a large full-thickness skin graft. The authors explain the peculiarities of this process in the sequelae of burn: indications, surgical technique, complications. They stressed the difficulties related to the "invisible loss" of skin, the "mandatory deficit" of the expansion, the expansion sub-scarring, the development of the treatment plan, the sustainability of the expansion.
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Hand burns are common. Aesthetic and functional consequences are mixed together. ⋯ Hand burns are frequent. Functional sequelae are often important: retractions, amputations. The orthopaedic treatment of these retractions is unspecific. We often use collagen substitute in our unit. The patient must be involved in his treatment, because it is very long and difficult.
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The use of microsurgery in the management of burn sequelae is not a new idea and free flaps have been used in this context since the 1970s. New technologies like negative pressure treatment and skin substitute have certainly decreased the indication of free flaps. ⋯ From a technical point of view, they find that realizing a free flap for these patients is more complicated (venous damage, lack of donor site who has been burned…). Despite this, microsurgery must still belong in the decision tree and there are some irreplaceable indication specially for hand reconstruction.
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Cervical and facial burns can be responsible of social and professional exclusions, functional limitations and psychological repercussions. Composite allotransplantation has become a reality for complex facial reconstructions. The purpose of this study is to evaluate the sequelae of third degree facial burns that might fit into a facial transplant program. ⋯ Third degree burns sequelae concerned mainly the neck and the lower third of the face. The indication of facial allotransplantation remains rare in the burn patient. The deep carbonisation and the very extensive burn patient with severe functional sequelae where the standard reconstructive procedures are inefficient might be eligible for a facial allotransplant program.