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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 5 of 7

A B C D E

Figure 1. A: A 25-year-old woman, who suffered thermal burn caused by alcohol, with a deep partial- and full-thickness burn covering
30% TBSA. There were injuries to the face, neck, anterior chest, and upper limbs. She presented severe mentocervical contracture; B: the
photograph shows the area following excision of the scar; C: the single-layer dermal matrix is shown in place; D: the split-thickness skin
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graft may be observed over the template; E: outcome at 12 months postoperatively after reconstruction with 135 cm of acellular dermal
matrix and autografts in a single-step procedure, without functional limitations; F: pinch test exhibiting pliability of the reconstructed skin.
TBSA: total body surface area

A B C D E

Figure 2. A: A 38-year-old woman, who suffered thermal burn caused by mineral spirits, with full-thickness burns that developed in
multiple keloid scars in the mentocervical region; B: defect after excision of keloid scars; C: the photograph shows the application of the
2
single-layer dermal matrix over the defect; D: result after placing 206 cm of dermal regeneration matrix and autografts in a single-step
procedure; E: Appearance at 10 months postoperatively. She did not present any functional limitations

A B C D

Figure 3. A: A 38-year-old woman, who suffered thermal burn caused by alcohol, with a full-thickness burn covering 30% TBSA; B:
2
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injured area after eschar removal; C: reconstruction with 210 cm of dermal matrix and autografts. She presented 5-cm graft loss that
was treated with autologous keratinocyte cultures; D: the picture shows the appearance at 9 months postoperatively. TBSA: total body
surface area
Recently, there has been an increased number of reports describing the use of several skin substitutes as a
good reconstruction alternative. Some of them, such as Glyaderm, Integra® bilayer, and biodegradable poly-
urethane dermal substitute, require a two-stage procedure consisting initially of a dermal matrix implanta-
[9]
tion and subsequently of skin grafting once there is complete take of the matrix. Seo et al. show a report of
24 neck reconstructions with a 95.9% take rate, under the use of AlloDerm and Matriderm, by placing the
skin graft immediately after the dermal matrix implantation in a single-stage procedure.