elastin and Hand-Injuries

The hands are involved in more than 80% of severe (grade IIb-III) burn accidents. Even if appropriate initial surgical care is provided in a timely manner, this does not necessarily guarantee a satisfactory outcome in terms of function and aesthetics if interdisciplinary postoperative care and patient compliance are inadequate. In the following case, a grade IIb-III burn, this led to unstable scars on the back of both hands and an intrinsic-minus hand position, bilaterally. Our case study demonstrates that even a delayed reconstruction with a collagen- elastin-based dermal substitute and split-skin graft combined with appropriate interdisciplinary postoperative care may lead to an excellent result comparable with the function and aesthetics of healthy hands, albeit with a significant effort.. Im Fall von schweren (IIb-III gradigen) Verbrennungen sind die Hände in über 80% mitbeteiligt. Auch die schnellstmögliche und richtige initiale chirurgische Versorgung sichert nicht zwingend ein funktionell und ästhetisch zufriedenstellendes Ergebnis, wenn die interdisziplinäre Nachsorge und Patientencompliance mangelhaft sind. In dem vorliegenden Fall führte dies bei einer IIb-III gradigen Verbrennung beider Hände zu instabilen Narbenverhältnisse im Bereich beider Handrücken sowie einer Intrinsic-minus-Handstellung beidseits. Wir zeigen, dass auch eine sekundäre Versorgung einer Verbrennungsnarbe im Bereich der Hände mit einem Collagen-Elastin-basierten Dermisersatz und nochmaliger Spalthauttransplantation mit dem richtigen interdisziplinären postoperativen Regime zu einem Ergebnis führen kann, das funktionell und ästhetisch einer gesunden Hand entspricht, jedoch mit einem deutlich erhöhtem Aufwand.

Topics: Cicatrix; Collagen; Elastin; Female; Follow-Up Studies; Hand Deformities, Acquired; Hand Injuries; Humans; Plastic Surgery Procedures; Postoperative Complications; Reoperation; Skin Transplantation; Wound Healing; Young Adult

The gold standard for the coverage of full-thickness skin defects is autologous skin grafts. However, poor skin quality and scar contracture are well-known problems in functional, highly strained regions. The use of dermal substitutes is an appropriate way to minimise scar contraction and, thereby, to optimise the quality of the reconstructed skin. The aim of this study was to evaluate the impact of the collagen-elastin matrix, Matriderm, for the single-step reconstruction of joint-associated defects of the upper extremity. Seventeen patients with full-thickness skin defects of the upper extremity were treated with the dermal substitute, Matriderm, and unmeshed skin graft in the functional critical region of the distal upper extremity in a single-step procedure. The take rate of the matrix-and-skin graft was 96%. Long-term follow-up revealed an overall Vancouver scar scale of 1.7. No limitation concerning hand function was observed; DASH-score analysis revealed excellent hand function in patients with burn injury and patients with a defect due to the harvest of a radial forearm flap achieved satisfying hand function. This matrix represents a viable alternative to other types of defect coverage and should therefore be considered in the treatment of skin injuries, especially in very delicate regions such as the joint regions. The possibility of performing a one-stage procedure is supposed to be a major advantage in comparison to a two-stage procedure.

Topics: Burns; Collagen; Elastin; Female; Hand Injuries; Humans; Male; Middle Aged; Plastic Surgery Procedures; Skin, Artificial; Surgical Flaps; Treatment Outcome; Vacuum; Wrist Injuries

Dermal substitutes are used increasingly in deep partial and full-thickness burn wounds in order to enhance elasticity and pliability. In particular, the dorsum of the hand is an area requiring extraordinary mobility for full range of motion. The aim of this comparative study was to evaluate intra-individual outcomes among patients with full-thickness burns of the dorsum of both hands. One hand was treated with split-thickness skin grafts (STSG) alone, and the other with the dermal substitute Matriderm(®) and split-thickness skin grafts.. In this study 36 burn wounds of the complete dorsum of both hands in 18 patients with severe burns (age 45.1±17.4 years, 43.8±11.8% TBSA) were treated with the simultaneous application of Matriderm(®), a bovine based collagen I, III, V and elastin-hydrolysate based dermal substitute, and split-thickness skin grafting (STSG) in the form of sheets on one hand, and STSG in the form of sheets alone on the other hand. The study was designed as a prospective comparative study. Using both objective and subjective assessments, data were collected at one week and 6 months after surgery. The following parameters were included: After one week all wounds were assessed for autograft survival. Skin quality was measured 6 months postoperatively using the Vancouver Burn Skin Score (VBSS). Range of motion was measured by Finger-Tip-Palmar-Crease-Distance (FPD) and Finger-Nail-Table-Distance (FNTD).. Autograft survival was not altered by simultaneous application of the dermal matrix (p>0.05). The VBSS demonstrated a significant increase in skin quality in the group with dermal substitutes (p=0.02) compared to the control group with non-substituted wounds. Range of motion was significantly improved in the group treated with the dermal substitute (p=0.04).. From our results it can be concluded that simultaneous use of Matriderm(®) and STSG is safe and feasible, leading to significantly better results in respect to skin quality of the dorsum of the hand and range of motion of the fingers. Skin elasticity was significantly improved by the collagen/elastin dermal substitute in combination with sheet-autografts.

Topics: Adult; Burns; Collagen; Elastin; Female; Graft Survival; Hand Injuries; Humans; Male; Middle Aged; Prospective Studies; Range of Motion, Articular; Skin; Skin Transplantation; Wound Healing

Restoring function after hand burns is still a great surgical challenge. Reconstitution of elasticity and pliability are of utmost importance for hand function and aesthetics results. Dermal substitutes have been developed and have been used for many years. The dermal substitute Matriderm® is an acellular three-dimensional matrix composed of native structurally intact collagen fibrils coated with elastin obtained from bovine dermis. The possibility of a one-stage procedure is profitable in treatment of hand burns. The authors report the case of a 43-year-old man admitted for severe burn by flames to 18% of his total body surface area with complete full thickness injury of left hand. After debridement incisions in emergency, early excision and skin graft using Matriderm® were performed. Physical therapy was established at Day 10. At six weeks follow-up, full range of motion was achieved and the patient was able to use his hand in daily activities.

Topics: Adult; Burns; Collagen; Elastin; Hand Injuries; Humans; Injury Severity Score; Male; Skin, Artificial

Restoring function after hand burns plays a major role in the restitution of a quality of life. Thereby the reconstructed pliability of the grafted areas is of utmost importance for good hand function. The collagen elastin matrix Matriderm was evaluated as a dermal substitute for the treatment of severe hand burns. In a series of 10 patients, mean age 43 years, TBSA 22.8%, an early debridement and immediate grafting with the matrix and unmeshed skin graft was carried out in a one-stage procedure. In the early postoperative follow up an overall take rate of 97% was observed. In contrast to conventional skin grafts, the color of the skin grafts over the matrix appeared pale in the first few days, but after 2 weeks no difference was observed. After three months, pliability of the grafted area was excellent, (mean VSS 3.2+/-1.2). Full range of motion was achieved in all hands, no blisters and no unstable or hypertrophic scars occurred. Matriderm has proved to be a dermal substitute suitable for the treatment of hand burns. We therefore consider Matriderm as a promising dermal substitute for the treatment of severe hand burns.

Topics: Adult; Burns; Collagen; Elastin; Female; Graft Survival; Hand Injuries; Humans; Male; Middle Aged; Skin, Artificial; Treatment Outcome