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Gaviria et al. Plast Aesthet Res 2018;5:35 I http://dx.doi.org/10.20517/2347-9264.2018.38 Page 3 of 7

tutes and STSGs, yielding an overall take rate of 95.9%, with only 1 patient showing recontracture. Nev-
ertheless, all patients from this study underwent late reconstraction, considering that the contracture was
already present as a burn sequela. To date there are no reports in the international literature demonstrating
this type of management in patients with acute burns, achieving positive results. In this regard, the present
study reports such management not only in 7 patients with irregular scarring but also in 2 patients exhibit-
ing acute burns.

The aim of this prospective, single-center, observational study was to describe the application of a single-
layer acellular dermal matrix, in combination with STSGs, in a one-stage surgical procedure in patients
with deep partial- and full-thickness neck burns, and sequelae.

METHODS
We report the use of a single-layer acellular dermal matrix (Integra®) for one-stage reconstruction of neck
defects following a full-thickness burn.

A descriptive longitudinal study was conducted at the Burn Unit of the Health Services Unit of Simón
Bolívar North Subnetwork E.S.E. of the Secretariat of Health in Bogotá, Colombia, from January 1 2016 to
December 31 2017. The study was approved by the Institution’s Ethics Committee, and it was based on the
ethical principles contained in the Declaration of Helsinki.

The study included 9 patients with deep partial- or full-thickness burns of any etiology and extension, in-
volving the neck either partially or totally, as well as patients who presented abnormal scarring on the neck
with or without retraction, who required definitive coverage with skin grafts after complete excision of the
scar lesion.

Patients were requested to sign an informed consent form to be able to participate in the study and have
their pictures taken. Patients showing additional comorbidities, including malnutrition, high blood pres-
sure, diabetes mellitus, and coagulation disorders, were excluded. Patients having severe mental disorders or
exposed areas not suitable for graft coverage were also excluded.

Surgical procedure
The dermabrasion or complete eschar removal was performed under general anesthesia in deep partial- and
full-thickness burns. After obtaining a clean wound free of necrotic tissue, the host area was rinsed with
isotonic saline solution, and electrocautery was used for hemostasis. Once the burn area was prepared and
ready, the single-layer acellular dermal matrix template was applied to the wound bed to achieve a complete
substitute of the full-thickness dermis. The single-layer acellular dermal matrix template (Integra®) was
placed, allowing 1 cm to extend beyond the wound edges. Next, the template was checked to ensure there
were no bubbles or hematomas. Immediately after this step, a STSG of 0.010″ was obtained from the dor-
solateral thigh with the use of an electric dermatome and fixed in place with surgical staples. Specialized
dressings were applied to the grafts in order to stabilize them and close the dead space, thereby lowering
complication rates.

Wound dressings were first uncovered on the 5th day and changed every 5 days until complete take of the
dermal matrix and skin autograft. Blisters, small hematomas or seromas were drained during dressing
change. In case of partial graft loss, the site was regrafted or closure was done by applying cultured autolo-
gous keratinocytes, thus, avoiding healing by secondary intention. Monitoring was conducted at 1, 2, 3, 6, 9,
and 12 months, and evolution was recorded through photography.