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Page 4 of 7 Gaviria et al. Plast Aesthet Res 2018;5:35 I http://dx.doi.org/10.20517/2347-9264.2018.38

An admission assessment was performed for each patient, and based on these findings, a physical and oc-
cupational therapy plan was designed with the aim of decreasing pain and edema, improving ranges of
motion, and controlling positioning and functionality for neck rotation and extension. Both the physical
and occupational therapies were suspended during the first 5 postoperative days and resumed with physical
reconditioning activities and orthotic management with splints in extension (110°), acupressure on the scar,
and the use of Lycra garments, silicone, lubricants, and moisturizers. Additionally, hypertrophic, red, inflex-
ible, firm, and raised scars were treated with steroid injections.

Statistical analysis
The socio-demographic variables age and sex were registered. Other clinical characteristics were registered
as well, including total burned body surface area using the Lund and Browder chart, burn depth, size of
the defect following complete necrotic tissue removal or total scar excision, amount of dermal matrix used
in square centimetres, autograft take percentage, and complications. Scars were assessed at month 1 and
month 12. For qualitative variables, frequencies and percentages were used, whereas for quantitative vari-
ables, mean and range were preferred. Microsoft Excel® was used.

RESULTS
A total of 9 patients were treated. Exposed areas required definitive coverage using a single-layer dermal
regeneration matrix and autografts in a one-stage procedure, following excision of keloid scars and scar
retractions (n = 7), and in the case of acute-phase deep burn wounds, following complete necrotic tissue re-
moval (n = 2). In this group, 5 patients were 1 woman and 4 men, with a mean age of 29.6 years (range 13-48
years).

Mean total body surface area affected was 30% (range 8%-70%). Most patients showed additional burns in-
volving the face, anterior chest and upper extremities, exhibiting deep partial- and full-thickness burns.

2
Mean treated area was 144 cm . No patient presented infection during postoperative follow-up. At 2 months
postoperatively, stability of treated area and adequate resistance of the skin substitute and autografts could
be observed. They appeared normal in color, with no degree of contractures or functional limitations. The
graft was smooth, flat, non-indurated, and elastic, and its color was very similar to the surrounding area.
Such characteristics improved over time [Figures 1 and 2].

Four of the nine patients showed signs of hypertrophic scarring at the edges of the graft, particularly in the
junction between the dermal matrix and normal skin, consisting of hyperemic, raised, and slightly indu-
rated scars having a width of less than 5 mm. They responded adequately to management with steroid injec-
tions and the use of Lycra garments, silicone gel, and acupressure.

2
One patient presented autograft loss of 5 cm at immediate postoperative follow-up, which was successfully
managed by applying cultured autologous keratinocytes [Figure 3].

DISCUSSION
Neck burns are difficult to reconstruct because of the cylinder-like structure and constant movement of the
neck. Among the most common challenges associated with deep neck burns is the high frequency of con-
tractures and functional impairments. Such deformities cause prolonged disabilities and social rejection.
Although multiple procedures have been described, including Z-plasty, W-plasty, local flaps, and free flaps,
STSGs continue to be recognized as the standard treatment, particularly for deep and extensive burns. Skin
[5]
substitutes have improved the quality of STSGs significantly, reducing and preventing recontractures . Ad-
ditionally, they are a good alternative for this area.