Deborah A E Maze¹, Gisela A Olson²

¹The Burns Unit & the Children’s Hospital at Westmead Burns Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW 2145 deborah.maze@health.nsw.gov.au

²The Burns Unit & the Children’s Hospital at Westmead Burns Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW 2145 gisela.olson@health.nsw.gov.au

Abstract

The management of full thickness facial burns can be challenging and complex. In 2017, our Burns Unit treated a 2 year old female who sustained a 60% TBSA full thickness flame burn injury involving the entire face.

Successful regeneration of dermal tissue is important in the restoration of normal functionality and aesthetic appearance. Advancements in the development of skin substitutes aim to provide improved elasticity, flexibility, stability and strength of the reconstructed skin whilst reducing wound contraction and improving scar appearance.

Surgical management of full thickness facial burns in our institution has previously involved early tangential excision (+/- temporary application of cadaveric skin) and split thickness sheet grafting.

This case study will demonstrate the use of Matriderm, a collagen-elastin matrix dermal substitute, applied in a one-stage surgical procedure in combination with a split thickness skin graft to reconstruct the full thickness facial burn wound, a first for the treatment of a paediatric full thickness facial burn in Australia.

Discussion will include initial wound management, the application process for Matriderm, challenges around wound management post skin grafting and complications experienced. An early scar management regime was initiated and included use of a transparent face orthosis and custom made compression garment. Initial skin graft results will be included along with the child’s outcome at 10 months post burn injury.

Matriderm has proven to be a successful dermal substitute in this case. Ongoing follow up will be required to determine the long term outcome of skin quality, pliability and scar appearance.

References

1. Atherton D, Tang R, Jones I, Jawad M. Early excision and application of Matriderm with simultaneous autologous skin grafting in facial burns. Plastic & Reconstructive Surgery, 2010
2. Demircan M, Cicek T, Yetis M. Preliminary results in single step wound closure procedure of full thickness facial burns in children by using the collagen-elastin matrix and review of paediatric facial burns. Burns, 2015
3. Min J, Yun I, Lew D, Roh T, Lee W. The use of Matriderm and autologous skin graft in the treatment of full thickness skin defects. Archives of Plastic Surgery, 2014
4. Haslik W, Kamolz L, Nathschlager G, Andel H, Meissl G, Frey M. First experiences with the collagen elastin matrix Matriderm as a dermal substitute in severe burn injuries of the hand. Burns 2006
5. Shevchenko R, James S, James E. A review of tissue-engineered skin bioconstructs available for skin reconstruction. Journal of The Royal Society Interface 2009
6. Suwelack A, MedSkin Solutions, Matriderm product information 2014