title: Integra Artificial Skin for burn scar revision in adolescents and children.
abstract: Integra Artificial Skin, a biosynthetic dermal template, is well established in acute burn surgery. The aim of the study was to determine the role of Integra in the surgical treatment of postburn scars in a younger population. Between March 1998 and November 2004, 17 patients (n=17; mean age=13.15 years) underwent complete excision of hypertrophic scars or keloids (1-4% TBSA; extremities=47%, head/neck=35%, trunk=18%) with subsequent implantation of Integra for defect closure. Split thickness skin grafting (STSG) of the Integra-derived neodermis was performed 3 weeks after the first operation. Scar excision and primary Integra implantation was successful in all but one patient (94%) who (6%) needed reimplantation once. Integra's mean take rate was 99.7% for all primarily successful patients. Complications occurred in three patients (18%), including minor problems without long-term consequences in 12% (seroma formation), and major problems in 6% (hematoma formation). Take rate of STSG ranged from 50% to 100% (mean 94%). Functional and cosmetic long-term outcome showed results scored "excellent" in 53%, "good" in 36%, and "fair" in 11%. Comparison of pre- and postoperative findings revealed a significant functional improvement in all and a considerable cosmetic improvement in all but two patients. These results suggest that Integra is a valid new treatment modality for extensive burn scar revision in younger patients.
authors.affiliation: Pediatric Burn Center, Plastic and Reconstructive Surgery, Department of Surgery, University Children's Hospital, Steinwiesstr. 75, CH-8032 Zurich, Switzerland. stiefel_d@yahoo.co.uk
authors.forename: Dorothea
authors.initials: D
authors.lastname: Stiefel
authors.forename: Clemens
authors.initials: C
authors.lastname: Schiestl
authors.forename: Martin
authors.initials: M
authors.lastname: Meuli
mesh_terms: D000293:Adolescent; D002056:Burns / Q000150:complications* / Q000473:pathology / Q000601:surgery; D002648:Child; D002809:Chondroitin Sulfates / Q000009:adverse effects / Q000627:therapeutic use*; D017439:Cicatrix, Hypertrophic / Q000209:etiology / Q000469:parasitology / Q000601:surgery*; D003094:Collagen / Q000009:adverse effects / Q000627:therapeutic use*; D004954:Esthetics; D005260:Female; D006801:Humans; D007627:Keloid / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D008297:Male; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation / Q000379:methods; D017768:Skin, Artificial; D016896:Treatment Outcome
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen