To explore the clinical effect of composite skin which was prepared by self-split-scar-tissue on repairing scar contracture deformity in functional site of severe burn children.

A total of 12 patients (7 males and 5 females)with age from 3 to 10 years were included in the group. All the patients were suffered from cicatricial contracture deformity after burn injury and admitted to Xijing Hospital of Air Force Medical University from March 2015 to March 2018. Scar contractures were located at the ankles, elbows, armpits and trunks. The scar adhesion contracture in the axilla resulted in the shoulder joint lifting movement at 30°-60°. Due to scar contracture, the angle of elbow joint elongation is only 45°-90°. Popliteal scar causes the knee joint to straighten at angle of 95°-110°. Scar contracture in the lateral chest and abdomen caused the ipsilateral nipple to move 5 cm downward, and the Central Line of standing position flexed to the affected side by about 20°.During operations, the cicatricial contracture was completely released, joint activity was restored, distortion organs were repositioned. After this, the secondary defect was formed, ranging from 5 cm×10 cm-11 cm×20 cm. The stable scar area (8 on the back and 6 on in the thigh) was chosen as donor site of thickness scar skin and the split thickness skin was harvested from scalp. The self-scar-tissue was taken from scar at a thickness of 0.5 mm and meshed at a ratio of 1∶1. The new composite skin was prepared by meshed self-scar-tissue as dermal matrix and split thickness skin as the cover. Then, the new composite skin was grafted on the secondary defect. Meanwhile, the split thickness scar-skin was replanted to the donor site after scar-dermal matrix had been harvested. The two surgical sites were routinely pressure-wrapped. The dressings were exchanged after 7-10 days to observe the skin graft survival and follow-up observation.

In 12 patients, a total of 14 composite skin grafts were used in the repair area. The composite skin were all prepared according to the size and shape of defect (50 cm² to 220 cm²) . Among them, 12 grafts survived well and 2 grafts caused partial skin necrosis due to infection (the two skin necrosis cases healed after dressing changing). The 14 split thickness scar-skins were all survived well on donor sites. A follow up from 2 to 24 months, the function and appearance of the ankles, elbows, armpits of the self-scar-tissue composite skin grafting and the donor site of split thickness scar-skin were both satisfactory. Postoperative elevation of shoulder joint contracture was 150°-170°. Elbow contracture patients can be basically straight, up to 170°-180°. Patients with knee contracture can be fully extended up to 180°. After the scar contracture of the side chest and abdomen was fully released, the affected side nipple returned to the normal position and the midline of standing position was basically normal. All the skin pieces in the replantation area of 14 scar epidermis survived well, and their appearance was not significantly different from that before surgery. The scalp donor area heals well without scar formation and hair loss.

This kind of novel composite skin can provide a hopeful method for the deformity recovery of severe burn children.

Children; Burn; Cicatrix; Composite skin; Transplantation