Microskin graft on contracture deformity of scar after extensive deep burn

Background:Contracture deformity of scar in late stage of extensive deep burn often neded repeated surgical platics and no fitful auto-skin of lacking were the common problems in clinic.Objective:To explore the effects of microskin graft on contracture deformity of scar after extensive deep burn.Unit:150th Hospital of PLA.Subjects:7 cases,23 locations of contracutre of scar were investigated including 3 males and 4 females,aged 14-46(mean:30)years old.Burn area was 76%-96% TBSA,with deep second degress over 65% and third degree over 90%. Operation regions:neck region,3 locatons,auxillary region,6 locations,elbow region,5 locations.wrist region,2 locations,popliteal fossa region,7 locations.Surgical opportunity:5 months-3 years after healing of wound surface.Source of heterogenous skin:Preserved with liquid nitrogen ,1 case:Fresh heterogenous skin,2 cases;From directly-related families,4 cases.Intervention:Adhesion was relaxed completely from contracture region to deep fascia at articular regions of limbs to achieve maximal degree of flexing and extending with no tension at edges of incision.If contracture of muscle and tendon affecting extending of joints was observed,muscle tendon might be pro longed.Exposing muscle tendon,nerve,vessels might be covered with peripheral tissues.Scars at neck,auxillary region must be removed or relaxed completely to restore function to normal or near to normal.Hemostasis must be complete.According to the ration of areas of providing and accepted skin,1 tp 6-8,intermediate thickness auto-skin was incised with rolling dermatome and clipped into 1 mm^2 of microskin that was sprinkled evenly on fitfully clipped heteropenous dermis.Heterogenous skin with mincroskin was grafted on wound surface,sutured,fixed and bandaged compressively with thick dressing.Neck,madnible,and auxillary region were bandaged with packaged and compressively and fixed with plaster support.After healing of graft wound surface,locak region must be compressed with elastic cover for 6-8 months and function exercises were taken to prevent hypertrophy of scar and second contracture.Resulty:Dressings were changed 7-8 days after operation,auto-skin was observed good,black blotch appeared in part of au toskin at about 3 weeks,fused into flat and sepaated.Auto-skin existed for a longer time and separated successively until wound surface was covereb by microskin in 16 locations,residual wound surface after heterogenous skin seperated in 7 locations healed after dressing was changed.After 1-3 years of follow-up,grafted skin was neat with mild scar,smooth surface and articular moving function and apperance were satisfying thwat was familiar to the effects of free lafge skin graft.Conclusiong:Microskin graft on deformity of joint and functional part was an effective method.

Microskin graft on contracture deformity of scar after extensive deep burn

Background:Contracture deformity of scar in late stage of extensive deep burn often neded repeated surgical platics and no fitful auto-skin of lacking were the common problems in clinic.Objective:To explore the effects of microskin graft on contracture deformity of scar after extensive deep burn.Unit:150th Hospital of PLA.Subjects:7 cases,23 locations of contracutre of scar were investigated including 3 males and 4 females,aged 14-46(mean:30)years old.Burn area was 76%-96% TBSA,with deep second degress over 65% and third degree over 90%. Operation regions:neck region,3 locatons,auxillary region,6 locations,elbow region,5 locations.wrist region,2 locations,popliteal fossa region,7 locations.Surgical opportunity:5 months-3 years after healing of wound surface.Source of heterogenous skin:Preserved with liquid nitrogen ,1 case:Fresh heterogenous skin,2 cases;From directly-related families,4 cases.Intervention:Adhesion was relaxed completely from contracture region to deep fascia at articular regions of limbs to achieve maximal degree of flexing and extending with no tension at edges of incision.If contracture of muscle and tendon affecting extending of joints was observed,muscle tendon might be pro longed.Exposing muscle tendon,nerve,vessels might be covered with peripheral tissues.Scars at neck,auxillary region must be removed or relaxed completely to restore function to normal or near to normal.Hemostasis must be complete.According to the ration of areas of providing and accepted skin,1 tp 6-8,intermediate thickness auto-skin was incised with rolling dermatome and clipped into 1 mm^2 of microskin that was sprinkled evenly on fitfully clipped heteropenous dermis.Heterogenous skin with mincroskin was grafted on wound surface,sutured,fixed and bandaged compressively with thick dressing.Neck,madnible,and auxillary region were bandaged with packaged and compressively and fixed with plaster support.After healing of graft wound surface,locak region must be compressed with elastic cover for 6-8 months and function exercises were taken to prevent hypertrophy of scar and second contracture.Resulty:Dressings were changed 7-8 days after operation,auto-skin was observed good,black blotch appeared in part of au toskin at about 3 weeks,fused into flat and sepaated.Auto-skin existed for a longer time and separated successively until wound surface was covereb by microskin in 16 locations,residual wound surface after heterogenous skin seperated in 7 locations healed after dressing was changed.After 1-3 years of follow-up,grafted skin was neat with mild scar,smooth surface and articular moving function and apperance were satisfying thwat was familiar to the effects of free lafge skin graft.Conclusiong:Microskin graft on deformity of joint and functional part was an effective method.