Initial experience of Integra in the treatment of post-burn anterior cervical neck contracture

Bilaminate bioartificial skin substitutes such as Integra have been described as a temporary substitute for autograft in acute burns. The aim of this study was to assess their role in the treatment of hypertrophic scarring and anterior neck contracture in the reconstructive phase of burns surgery. Five patients underwent Integra grafting over a 12-month period, with one patient having the procedure performed on two separate occasions. One patient had a combination of hypertrophic scarring of the face and neck contracture, and two patients suffered from recurrent folliculitis in hypertrophic scars in the bearded area of the neck. Mean hospital stay was 24 days (range, 19-30 days). Mean follow-up was 48 months (range, 43-54 months). In all cases of neck contracture a superior cosmetic result was achieved. Recurrence of contracture of greater than 50% occurred within the follow-up period in all cases. Ineffective immobilisation of the graft and overgranulation were identified as contributing to contracture recurrence. Based on our initial experience bilaminate artificial skin substitutes offer an improved cosmetic result in cases of neck contracture and hypertrophic scarring, particularly in the bearded area of the neck. Recurrence of neck contracture remains a problem despite improved techniques of immobilisation. Long-term follow-up will be necessary to assess the applications of this technique fully. (C) 2000 The British Association of Plastic Surgeons.