[Clinical application and pathological observation of acellular allogeneic dermal matrix in repairing unstable burn scar].

OBJECTIVE: To evaluate the clinical effect and the pathological characteristics of acellular allogeneic dermal matrix in repairing unstable burn scar. METHODS: From January 2007 to June 2008, 19 cases of unstable burn scars (24 parts) were treated, including 16 males (20 parts) and 3 females (4 parts) with a median age of 27 years (range, 3-58 years). The injury was caused by flame (14 cases, 18 parts), electricity (4 cases, 5 parts), and hot water (1 case, 1 part). The unstable burn scars located on hands (8 cases), forearms (2 cases), thighs (3 cases), legs (2 cases), feet (2 cases), chest (1 case), and abdomen (1 case). Scar formed for 3 months to 1 year. The area of defect varied from 7 cm x 5 cm to 22 cm x 15 cm after scar removal. Defects were covered with acellular allogeneic dermal matrix and autogenous split-thickness skin graft. At 6-18 months after operation, the pathological observations of the epidermis, the basal membrane, and structural components of the dermis were done. RESULTS: All wounds healed by first intention. Scar ulcer disappeared completely in 18 cases and the composite skin grafts all survived. Some blisters occurred in 1 case and were cured after dressing changing. All patients were followed up 10 months to 2 years (18 months on average). The grafted-skin was excellent in the appearance, texture, and elasticity. The function recovered well. Only superficial scar was observed at skin donor sites. Pathological observation showed that the epidermis and the basal membrane of the skin grafts were similar to that of normal skin, and no significant difference was found in newly capillaries between them. Collagen fibers arranged regularly, and there were few inflammatory cells in the matrix. CONCLUSION: Acellular allogeneic dermal matrix with autogenous split-thickness skin graft may effectively repair the wound after removing the unstable burn scar, and its structure is similar to that of normal skin.