title: Use of dermal regeneration template in contracture release procedures: a multicenter evaluation.
abstract: Integra dermal regeneration template (Integra Life Sciences, Plainsboro, N.J.) is an effective treatment for full-thickness burns. It can also be useful in contracture release procedures; however, the clinical utility of a dermal regeneration template in contracture release procedures has not been adequately characterized. In this multicenter investigation, the outcomes of release procedures incorporating a dermal regeneration template for 89 consecutive patients, who underwent a total of 127 contracture releases, were retrospectively evaluated. The procedures involved the application of Integra, which includes a temporary silicone epidermal substitute and an artificial dermal layer. After formation of a neodermis, the silicone layer is removed and replaced with an epidermal autograft. Data on patient and contracture site history, treatment methods, physician assessments of range of motion or function, patient satisfaction, recurrence, and adverse events were collected with a standardized questionnaire. Release procedures for the study patients involved the neck, axilla, trunk, elbow, knee, hand, and other anatomical sites. The mean postoperative follow-up period was 11.4 months. At 76 percent of the release sites, range of motion or function was rated as good (significant improvement in range of motion or function) or excellent (maximal range of motion or function possible) by physicians. Responding patients expressed satisfaction with the overall results of treatment at 82 percent of the sites. No recurrence of contracture at 75 percent of the sites was observed during follow-up monitoring. Patient age and prior surgical treatment at the site did not significantly affect the results of treatment. However, outcomes were superior at mature sites, i.e., those for which more than 12 months had elapsed since the original injury. Postoperative complications rarely necessitated regrafting. These results indicate that a dermal regeneration template provides a useful alternative technique for contracture release procedures. The study data indicate that this approach leads to favorable functional outcomes and a high rate of patient satisfaction. This modality also seems to be versatile, because a range of anatomical sites are amenable to treatment with a dermal regeneration template, regardless of prior surgical treatment, and both pediatric and adult patients respond well to this form of therapy. Furthermore, Integra confers functional and cosmetic benefits similar to those of full-thickness grafts but without comparable potential for donor-site morbidity.
authors.affiliation: St. Andrew's Centre for Burns and Plastic Surgery, Broomfield, United Kingdom. framejames@aol.com
authors.forename: James D
authors.initials: JD
authors.lastname: Frame
authors.forename: Joseph
authors.initials: J
authors.lastname: Still
authors.forename: Anne
authors.initials: A
authors.lastname: Lakhel-LeCoadou
authors.forename: Michael H
authors.initials: MH
authors.lastname: Carstens
authors.forename: Christian
authors.initials: C
authors.lastname: Lorenz
authors.forename: Hermann
authors.initials: H
authors.lastname: Orlet
authors.forename: Robert
authors.initials: R
authors.lastname: Spence
authors.forename: Alfred C
authors.initials: AC
authors.lastname: Berger
authors.forename: Eric
authors.initials: E
authors.lastname: Dantzer
authors.forename: Andrew
authors.initials: A
authors.lastname: Burd
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002809:Chondroitin Sulfates; D002921:Cicatrix / Q000601:surgery*; D003094:Collagen; D003286:Contracture / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D016038:Skin Transplantation; D017768:Skin, Artificial; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen