Caveats and Technique for the Reconstruction of Burn Contractures Using an Artificial Dermis in a Tropical Burns Centre

There is a paucity of data on the use of dermal substitutes in a tropical burns centre, as its use was previously complicated by a high infection rate in the Southeast Asian region, further hindered by high costs. We hence describe our successful experience with a bi-layered artificial dermis (PelnacTM) and thin split-thickness skin graft (STSG) in treating post-burns hypertrophic scars and contractures when a lack of donor sites precluded reconstruction with traditional locoregional flaps. A two-staged procedure comprising artificial dermis and STSG was used to reconstruct full thickness wounds after excision of burns contractures over 11 sites (5 patients) three wrists, three necks, two ankles, one elbow, one chin, and one ear auricle. Time to skin grafting was 18.4 days, with a 100% STSG take. One wound (9%) developed hypertrophic scarring around its border but the rest healed with a pliable consistency and satisfactory cosmetic outcome. Full range of motion was restored in treated scars located over joints. No infective complications were encountered. We demonstrate that a bi-layered artificial dermis with STSG may be used reliably in a tropical burns centre with no infective complications, whereby a consistent technique contributes greatly to its success.