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Page 2 of 7 Gaviria et al. Plast Aesthet Res 2018;5:35 I http://dx.doi.org/10.20517/2347-9264.2018.38

Keywords: Neck, burns, matrix, template, reconstruction

INTRODUCTION
Modern burn care is based on operative wound management. There is clear evidence that immediate exci-
sion and closure are lifesaving for patients.

Significant reconstructive and rehabilitative challenges associated with neck burns must be addressed in
aesthetic units. Acute care will greatly influence the succeeding scarring, reconstructive needs, and long-
term outcomes. In most cases, reconstruction will encompass the restoration of both form and function of
[1]
soft tissue. The procedures used will highly depend on the level of local scarring .

The neck is a difficult area to reconstruct because of its cylinder-like dynamic structure. Severe neck burns
are followed by various expected deformities: neck contracture with limited range of motion, problems with
oral ability, and chin contracture with eversion of the lower lip, affecting both eating and speech. Thus, the
[2]
initial reconstruction method selected by the surgeon will determine the functional and final aesthetic result .
Neck reconstruction techniques are conditional on the extent of the release and type of defect, as well as on
the institution’s financial resources. In small areas having no exposed deep structures, full-thickness skin
grafts are a good option, whereas for larger defects with no exposed deep structures, split-thickness skin
grafts (STSGs) are indicated. Regional skin expansion is also described, along with free flaps, including the
anterolateral thigh flap and the thoracodorsal artery perforator flap in the case of exposed deep structures.
Normally, reconstruction following neck contracture release with STSGs produces poor results due to an el-
[3]
evated rate of recontractures. Greenwood and Mackie attribute this phenomenon to natural graft contrac-
tile tendency, to pain precluding mobility, and to platysma contraction. Better results have been reported
with full-thickness skin grafts, with the drawback of limited donor sites, particularly in young and lean
patients.

Skin substitutes are another alternative for neck reconstruction. They have the advantage of being simpler
procedures, compared to free flaps, exhibiting less secondary contracture than STSGs, and offering usability
[4]
in large neck reconstruction areas .

The implementation of dermal templates to effectively treat wounds is based on an appropriate debridement
and a well-vascularized host bed. Applying dermal templates on contaminated wounds entails a high risk
of infection, since dermal templates have a limited ability to fight infection. Once it has been applied, fibro-
blasts, endothelial cells, and inflammatory cells migrate into and repopulate the dermal template, ultimately
replacing the scaffold. A thin STSG may be applied for wound coverage after template take in large wounds.
The dermal template may be grafted at the time of its application in a well-vascularized wound if a thin
scaffold is used .
[5]
There are only a few published studies that have used a dermal matrix with a skin autograft in a one-stage
[3]
repair. In 2011, Greenwood and Mackie reported 1 case, in which Matriderm collagen/elastin dermal ma-
trix plus STSGs were used in a one-stage repair after a neck contracture release, yielding positive results.
Other substitutes, such as Glyaderm, based on glycerinized donor skin, Integra® bilayer, and biodegradable
polyurethane dermal substitute, have been used for neck reconstruction. However, all of them require two
[6-8]
surgical procedures, where a skin graft is placed 3 weeks following take of dermal matrix .

[9]
Another study published by Seo et al. in 2014 describes a retrospective analysis of 28 patients with post-
burn severe cervical contractures, which were reconstructed in a single-stage procedure with skin substi-