Application of composite skin grafts on the joint functional area of the limbs in patients with deep burn

Objective To investigate the effects of acellular dermal matrix (ADM) grafting on the functional area of joints in patients with deep burn. Methods A total of 11 patients with II or III degree burn in the joints of the limbs were enrolled into this study. Twenty pieces of reticulated allogeneic ADM (sized 150-400 cm2) were overlapped with 0.05-cm thick autogenous ultrathin split-thickness skins (UTSG) to form composite skin (CS) grafts. The CS grafts were then transplanted to 14 joint areas with eschar-excised or eschar-shaved burn wounds in the 11 patients. Autogenous split-thickness skin grafts (STSG, 0.15-0.20 cm in thickness) were transplanted into the neighboring areas as a control. 10-14 days after the transplantation, the dressings were changed for the first time. During a long-term follow-up, the pathology of the skin grafts were observed regularly. Results Two weeks after grafting, the survival rate of CS grafts was 93.7%, and that of STSG grafts was 97.2%. No significant difference exited in the survival rate between the two groups (P0.05). During a 1 to 3 years follow-up, no hypertrophic scar and contracture were found in the CS grafted areas, all the patients could bend and stretch their injured joints normally. Light microscopy showed that there was no skin appendage, collagen fibers were lined up orderly, and only a small number of lymphocytes infiltrated into the CS dermal layer. Furthermore, the effects of CS grafting (include the appearance texture and histological structure) on the clean wound at an early stage after burn injury was better than that at a late stage. Conclusions ADM as a dermal substitute should be grafted to the injured joint areas in the patients with deep burn as early as possible. The graft can produce satisfactory plastic results and recover the functions of the joints.