Matriderm and Split Skin Grafting for Full-Thickness Pediatric Facial Burns

Facial burns remain a complex reconstructive challenge. Achieving the plastic surgical goals of restoring form and function is difficult in these cases, with poor cosmetic results, reduced facial animation, and oral and ocular contractures a common result. In recent years, the use of dermal substitutes in combination with skin grafts has shown promising results in complex burn reconstruction. A 3-year-old girl was admitted to our pediatric tertiary referral center with 60% TBSA full-thickness burns, involving all skin above the waist including the face and neck. She underwent staged debridement of burnt tissue and temporary coverage with cadaveric skin over a 2-week period. Facial reconstruction was achieved by placement of Matriderm acellular dermal matrix covered with sheet split skin grafts, both in aesthetic subunits, at 2 weeks post-burn. Graft take on day 5 was 95%, with the small area of loss successfully regrafted. Twelve-month follow-up demonstrates great aesthetic results in terms of texture and color, as well as normal ocular and near-normal oral function. Use of Matriderm beneath split skin grafts demonstrates promising results for both aesthetic outcome and functional skin movement in burn reconstruction. Our results provide early evidence in favor of this new technique in full-thickness facial burns in pediatric patients.