Ten-year Follow-up After Treating Extended Burn Scar Contracture with an Autologous Cultured Dermal Substitute

Abstract

This is the first case report of long-term follow-up after applying the autologous cultured dermal substitute to establish the wound bed before split skin graft. The results suggest that application of autologous cultured cultured dermal substitute contributes to establish the high-quality wound bed for skin graft. Split-thickness skin grafts (STSGs) are the gold standard for the treatment of burn scar contracture. Young patients in particular may require additional skin grafts as they grow, and donor site for skin grafts may be limited. We applied autologous cultured dermal substitutes (CDSs) that are expected to establish a high-quality wound bed to allow thin STSGs. This is the first report of follow-up after application of autologous CDS combined with thin STSG. A male neonate suffered third-degree burns (20% of the total body surface area) on the back. After 2 years, scar contracture of the gluteal regions were released and autologous CDS were applied. Five days after the treatment, a super thin (4-6/1,000 per inch) skin grafting was performed. After 3 years, scar contracture of the back was released and autologous CDS was applied for 2 weeks. Then a split-thick graft was harvested from the same donor site. Ten years after the last operation, the width of the skin graft on his back has extended from 5-8 cm. The contour of the grafted skin is soft, smooth, and can be pinched. This long-term result shows the autologous CDS can be expected to establish the high-quality wound bed that allows thin STSG.

Fig. 1.

A male neonate has burns on his back that affects 20% of his total body surface area.

Fig. 2.

After 3 years, the scar contracture, which involved the deep fascial layer on his back was released. A wound bed was established by applying autologous cultured dermal substitutes for 2 weeks.

Fig. 3.

The donor site of a previous super-thin skin graft did not involve hypertrophic scarring.

Fig. 4.

Ten years after the patient’s last scar-releasing surgery, the skin graft has expanded along with the patient’s natural growth. The contour of the grafted skin is soft, smooth, and can be pinched.