title: Management of facial burns with a collagen/glycosaminoglycan skin substitute-prospective experience with 12 consecutive patients with large, deep facial burns.
abstract: Management of deep facial burns remains one of the greatest challenges in burn care. We have developed a protocol over the past 20 years for management of facial burns that includes excision and coverage with thick autograft. However, the results were not perfect. Deformities of the eyelids, nose and mouth as well as the prominence of skin graft junctures demonstrated the need to explore novel approaches. Integra has been used with success in the management of burns of the trunk and extremities. The purpose of this study was to prospectively evaluate the aesthetic outcome of the use of Integra for deep facial burns. Twelve consecutive patients underwent excision of large, deep facial burns and placement of Integra. Integra provides excellent color and minimally visible skin graft junctures. The texture is good but not as supple as thick autograft. Integra is not well suited for use in the coverage of eyelid burns due to the need to wait 2 weeks for adequate vascularization. In summary, thick autograft remains the gold standard for deep facial burns. However, for patients with extensive burns and limited donor sites, Integra provides an acceptable alternative.
authors.affiliation: The Burn Center at Harborview Medical Center, University of Washington, Seattle, WA, USA.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Klein
authors.forename: Loren H
authors.initials: LH
authors.lastname: Engrav
authors.forename: James H
authors.initials: JH
authors.lastname: Holmes
authors.forename: Jeffrey B
authors.initials: JB
authors.lastname: Friedrich
authors.forename: Beth A
authors.initials: BA
authors.lastname: Costa
authors.forename: Shari
authors.initials: S
authors.lastname: Honari
authors.forename: Nicole S
authors.initials: NS
authors.lastname: Gibran
mesh_terms: D000328:Adult; D001672:Biocompatible Materials / Q000627:therapeutic use*; D002056:Burns / Q000601:surgery*; D002809:Chondroitin Sulfates; D003094:Collagen; D004954:Esthetics; D005143:Eyelids / Q000293:injuries / Q000601:surgery; D005151:Facial Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods*; D012880:Skin Pigmentation; D016038:Skin Transplantation / Q000379:methods; D017768:Skin, Artificial; D016896:Treatment Outcome
chemical_list: D001672:Biocompatible Materials; C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen