Abstract:
Introduction. Large surface skin defect closure after extensive burn trauma remains an important issue in plastic and
regenerative surgery. Deficit of intact skin dictates a careful and creative approach to donor skin surfaces. Skin stretching
technique using endo expansion device is a promising approach to treat large skin defects. It allows a significant reduction
of scar surface area. Application of this technique for free dermal transplants allows receiving skin grafts similar to normal
skin.
The goal of this approach is to form a full-thickness skin flap of a desired size in cases where traditional skin donor
surface areas are limited or not available. The resulting skin flap could be used on various body parts.
The purpose of the study is to further characterize and advance the method of skin surface expansion for auto-grafting.
Purpose: to increase the potential of the expansion dermotension.
Materials and methods. In 2006-2017 years 25 patients age 4 years to 17 years with large-surface skin defects were
treated using skin stretching technique. 24 patients had burn trauma and one patient had a trauma related to a car accident.
All patients had scar deformations and various degrees of contractures, which were associated with significant limitations
in their everyday life.
Either large (120 mm x 45 mm) or small (90 mm x 45 mm) skin stretching devices were placed endoscopically. Radio
knife “Surgitron” and hydro knife “Versa jet” were used for incisions. Skin stretching was achieved by gradual expansion of
latex ballooning devices using 0.9% Normal Saline over a period of 4-8 weeks. Various body areas were used as a donor site
for skin stretching based on individual cases- back, lateral chest and abdomen.
4 patients received local intra dermal injections of botulinum toxin at the site of implantation of skin expansion device
3-4 days prior to the procedure.
Results. Using skin stretching devices we were able to get full-thickness donor skin surfaces ranging from 60 square
centimeters to 300 square centimeters. Wounds were closed using adjacent skin tissue. Small linear normotrophic scars
were formed as a result. 4 patients had some degree of peripheral necrosis at the edges, which were successfully treated
using conservative methods. Scar deformations and contractures were corrected in all patients.
Conclusions. Skin stretching technique has been proven to be a useful method in managing large surface skin defects
in pediatric patients with various burn trauma, scar contractures, other traumatic causes of skin defects. Skin stretching technique allows receiving a full-thickness auto skin graft of a desired size similar to normal skin. This method solves a problem
with lack of skin auto-graft for closure of large surface wound areas.
