The role of dermal substitutes and facial aesthetic subunits in burn scar resurfacing

Sinem Gultekin¹, Elizabeth Concannon², Lauren Middleton², Nicholas Solanki², John Greenwood²,
¹Royal Hobart Hospital, Hobart, Tasmania, Australia
²Adult Burns Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia

Abstract

Objectives:
This study details our experience using two-stage dermal substitute, Biodegradable Temporizing Matrix (BTM), and autologous skin graft for secondary burn scar resurfacing of diffuse hypertrophic facial burns in a young, cosmetically sensitive patient.
Methods:
A 29-year-old female sustained 70% full thickness burns affecting her head, neck, chest, abdomen, bilateral upper and lower limbs, requiring extensive acute debridement and skin graft procedures. We describe the application of staged BTM and split thickness skin graft for reconstruction of extensive facial burn scars with a paucity of donor sites for full thickness skin graft harvest.
Results:
BTM is a completely synthetic dermal matrix comprised of a biodegradable polyurethane foam bonded to a non-biodegradable polyurethane sealing membrane. The case review illustrates the successful use of dermal substitute BTM for facial burn scar reconstruction using a facial aesthetic subunit approach, with excellent cosmetic and functional results. Post-operative scar rehabilitation is also described.
Discussion:
Dermal substitutes play an integral role in providing wound cover for major burns, allowing limited autologous donor sites to be utilised in a staged, controlled fashion appropriate to the patient’s condition. Two-stage BTM reconstruction has proven robustness in the face of scar contracture compared with other popular dermal matrices, physiologically covering excised burn wounds, allowing for early rehabilitation and excellent scar cosmesis, exemplified in this case report.
Conclusion:
Dermal matrices such as BTM play an important role in secondary facial burn scar resurfacing and may achieve excellent results when managing deep burns affecting this cosmetically sensitive location.

Biography

Sinem Gultekin is a current plastic surgery registrar at Royal Hobart Hospital with an interest in general plastics and burns.