Elsevier

Burns

Volume 38, Issue 7, November 2012, Pages 998-1004
Burns

Assessment of burned hands reconstructed with Integra® by ultrasonography and elastometry

https://doi.org/10.1016/j.burns.2012.02.017Get rights and content

Abstract

Introduction

Hand injuries have major psychological, social and professional repercussions. Treatment of burned hands is suggested to be early and optimal to avoid catastrophic consequences and allow social and professional rehabilitation. Our study analyses the long-term results obtained with Integra®, a dermal substitute used for the treatment of deep burns of the hands.

Patients and methods

A total of 29 hands were treated with Integra®. Long-term monitoring was performed on 12 hands with a clinical, ultrasonographic and elastometric study. The results were compared with those from a series of healthy hands. This study, with a low number of subjects, is a pilot report.

Results

This study showed a low complication rate, with a high percentage of engraftment of thin skin, and good cosmetic and functional quality. The thickness and viscoelasticity of the skin treated with Integra® in our series appeared to be similar to those of healthy skin.

Conclusion

Integra® artificial skin is an attractive alternative in the treatment of deep burns of the hand and can achieve results with aesthetic and functional characteristics that are close to those of healthy skin.

Introduction

In addition to being one of the most visible parts of the body, the hands and the face are the most exposed to burns. The hands are involved in more than 50% of burns (results are provided by the SFETB, Société Française d’Etude et de Traitement de Brûlés, the French society of burn treatment). Treatment of these lesions has evolved since the 1950s, reducing the consequences for patients with improved socio-professional rehabilitation.

Treatment is a function of burn severity. First-degree and superficial second-degree burns can be treated only with topical antiseptics (silver sulphadiazine with or without cerium nitrate). Deep burns involve early excision and skin graft, immobilisation with a palmar splint (maintaining the metacarpophalangeal joint at 90°, the finger in full extension, the thumb in abduction and the wrist in neutral position) and early and intensive physiotherapy to allow healing with the least aesthetic and functional sequelae [1], [2], [3], [4].

Integra® has been used since 1981 because of its different properties in the treatment of deep burns [5], [6], [7], [8], [9], [10]. It is used in treatment of burned hands for cosmetic and functional purposes [11], [12].

We were interested in demonstrating that deep hand burns treated with Integra® were identical to healthy hands in terms of function. Several publications have reported the clinical and histological results obtained with Integra® [5], [7], [10], [12], [13], but few have attempted to objectively study the scar obtained after using this dermal substitute [14], [15], [16], [17], [18]. We wanted to study the thickness of the scar corresponding to the neo-derm obtained by the colonisation of Integra® and the split-thickness skin graft (SSG), and compared it to healthy skin; we used ultrasonography to obtain objective results. We also wanted to study the mechanical properties of skin after deep burns were treated with Integra® and SSG and observe if there were a difference from healthy skin. These mechanical properties were represented by elastic and viscoelastic qualities, extensibility and flexibility of the skin. These different properties were studied by elastometry (with a Cutometer). The features were measured with non-invasive physical techniques.

Section snippets

Patients

This retrospective study was conducted at our burn centre from 1998 to 2009. A total of 22 patients (9 women and 13 men), a total of 29 hands, were treated with Integra® and SSG for deep burns of the hands during this period. The average age was 37.6 years (14–93 years).

Long-term clinical, ultrasonological and cutometrical monitoring was performed in 10 patients and 12 hands, with a mean of 62 months (24–96 months). All patients received initial treatment with Flammacerium® dressing up to the

Initial treatment

Twenty-two patients were treated with Integra®. The average TBSA was 42.4% (0.5–81.5%). The localisation and depth of the burns are shown in Table 1. Fifteen hands presented a 3° burn (adipocyte tissue expositions) and 14 hands a 4° burn (tendon, bones or joint expositions). The average period between burn and skin excision followed by covering with Integra® was 6.4 days (1–34 days) (Fig. 3(a) and (b)). The average take rate for Integra® was 76%. Eight hands required complementary treatment by

Discussion

The average period between burn and Integra® application was quite long when compared with classical early excision (from day 1 to 5) [2], [21], [22], [23], [24]. This can be explained by the high TBSA average (42.4%) and hospital department requirements (lack of availability of the operating room, etc.).

In 24% of the cases (eight cases), a complementary Integra® application needed to be performed owing to complications (haematoma, infection, etc.) or lack of integration (secondary to lack of

Conclusion

Treatment with Integra® and SSG for deep burns of the hands provided elastic recovery and aesthetic and functional qualities that were nearly identical to healthy skin, even if the skin thickness was greater, as subjective and objective tests, ultrasonography and elastometry revealed.

Conflicts of interest statement

The authors confirm that there is no conflict of interest.

Authors have no financial or personal relationships with other people or organisations that could inappropriately influence or bias our work.

References (35)

  • A. Heitland et al.

    Update on the use of collagen/glycosaminoglycate skin substitute-six years of experiences with artificial skin in 15 German burn centers

    Burns

    (2004)
  • L. Bargues et al.

    Incidence and microbiology of infectious complications with the use of artificial skin Integra® in burns

    Ann Chir Plast Esthet

    (2009)
  • P.P. van Zuijlen et al.

    The prognostic factors regarding long-term functional outcome of full-thickness hand burns

    Burns

    (1999)
  • S.S. Fong et al.

    The Cutometer and ultrasonography in the assessment of postburn hypertrophic scar: a preliminary study

    Burns

    (1997)
  • W. Boeckx et al.

    Fibrin glue in the treatment of dorsal hand burns

    Burns

    (1992)
  • R.L. Sheridan et al.

    The acutely burned hand: management and outcome based on a ten-year experience with 1047 acute hand burns

    J Trauma

    (1995)
  • D.J. Barillo et al.

    Prospective outcome analysis of a protocol for the surgical and rehabilitative management of burns to the hands

    Plast Reconstr Surg

    (1997)
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