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Page 6 of 10 Madiedo et al. Plast Aesthet Res 2018;5:40 I http://dx.doi.org/10.20517/2347-9264.2018.40

A B

C D

Figure 3. A 16-year-old female patient with a full-thickness flame burn to the left upper limb. A: Exposed area suitable for grafts; B:
coverage with split-thickness skin grafts placed transversely; C: appearance by postoperative day 45; D: appearance after 6 months, with
no functional limitations

A B C D

Figure 4. A 24-year-old male patient with a full-thickness chemical burn (sulfuric acid) to the left upper limb, involving creases. A: Initial
appearance, with an adhered and hard eschar; B: formation of a uniform and non-hypertrophic granulation tissue. It was red and had
no discharge following two escharectomies. It was covered temporarily with skin allografts; C: placement of split-thickness skin grafts
transversely soon after surgery; D: appearance at postoperative month 1

joints, pain degree, and presence and severity of edema, resulting in functional limitation of the involved joint.
Sensitivity exhibited mixed impairment, with areas of hyperesthesia associated with superficial burns and
areas of hypoesthesia associated with deep burns, as well as non-painful areas corresponding to full-thickness
burns. Patients showed decrease in strength, range of motion (ROM) impairment and activities of daily living
(ADLs) limitations. This resulted in weakened or non-functional upper and lower limbs, making patients
highly dependent.

At week 4 postoperatively, patients having a VSS score below 7 showed resolution of edema, a decrease to 0 for
pain at rest and during activity (VAS), and gradual improvement of sensitivity during the following 6 months,
as deep sensitivity was regained. There was an increase in strength, as well as greater gains in ROM and
complete resumption of instrumental and non-instrumental ADLs. The 4 patients who developed infection
and exhibited graft loss in affected areas showed scarring disorders, with signs of hypertrophic scars and
keloids, cutaneous and subcutaneous contractures, and fascia contracture. None of them presented ligament