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Page 6 of 7 Gaviria et al. Plast Aesthet Res 2018;5:35 I http://dx.doi.org/10.20517/2347-9264.2018.38

Even though this study is a preliminary report of a short series of 9 cases, the results obtained allow the
development of comparative studies encompassing the different techniques used for post-burn neck recon-
structions, comparing them with STSGs or other skin substitutes. It is worth noting that this is the first case
series demonstrating that the use of a single-layer acellular dermal matrix (Integra®) in a one-stage recon-
struction of neck defects following a full-thickness burn is an effective, safe and excellent reconstructive op-
tion in managing both acute burns and sequelae.

[9]
Along the same lines of the results described by Seo et al. with AlloDerm and Matriderm, the use of In-
tegra Single Layer in this study yielded comparable results, including the following: short operating room
times, with no complications and excellent functional and cosmetic results in such a difficult-to-treat area.
As may be observed from the photographs presented, there is good color match in the grafted area. The use
of skin substitutes offers alternative solutions aimed at successfully treating complex soft-tissue defects, op-
timizing the quality of the reconstructed skin [10-12] .

In Colombia, the other skin substitute available is the Integra® bilaminar dermal regeneration matrix within
the framework of current practice regarding skin substitutes, consisting of a two-stage surgical procedure:
application of the dermal regeneration template to the wound and, following a 2-4 weeks’ interval, the re-
placement of the silicone pseudoepidermal layer of the template with a thin-thickness skin autograft. The
increased number of surgeries, a prolonged hospitalization and the need of additional immobilization are
patent disadvantages of this two-step repair. Furthermore, the time required for the dermal matrix to fully
integrate causes prolongation of the inflammatory phase, increasing the possibility of fibrosis and scar re-
traction [13-15] . The Integra® bilaminar dermal matrix has proven to entail a higher risk of infection, as a 3-week
[16]
interval is required to allow take before placing skin autografts. Lohana et al. report that the risk of infec-
tion is higher in such cases.

In the case of deep and extensive neck burns, where insufficient donor skin is available for full-thickness
skin grafts, which require coverage with STSGs, we consider that the use of dermal matrices may be con-
templated as a first surgical option to improve STSG outcomes. This would decrease the high postoperative
contracture rate and poor functional results observed in these areas.

A parameter that we consider to be important for the success of this procedure is the preparation of a well-
vascularized, non-infected wound bed, before applying the dermal matrix and skin graft. Adequate surgical
debridement is crucial and mandatory. Stabilizing the single-layer acellular dermal matrix and the skin graft
through the use of pressure dressings is also essential for a successful outcome.

No unstable or keloid scars were recorded; pliable skin and excellent elasticity of grafted areas was docu-
mented, without scar contractures or serious functional limitations. Cosmetic appearance of grafted sites
was equally acceptable.

In conclusion, our efforts were centered on choosing the appropriate techniques that will provide good
functional and cosmetic results. The use of an artificial dermal matrix in a one-step surgical approach al-
lows rapid healing and early mobilization of the neck, and in some cases, it may reduce the need for local or
regional flap or free flap coverage. Moreover, it is associated with excellent skin formation, good functional
and aesthetic results, and low donor-site morbidity. Therefore, it should be considered as an alternative to
other reconstruction techniques, particularly when covering highly demanding areas, such as the neck.

DECLARATIONS
Authors’ contributions
Concept and design, data analysis, manuscript preparation, critical revision and finalizing of the manuscript:

GaviriaJL, Gómez-OrtegaV

Data acquisition: GaviriaJL