A 13-Year Experience With a 3-Stage Dermal Regeneration Matrix Approach to Hand Burns

Area of Science:

• Regenerative medicine
• Burn surgery
• Reconstructive surgery

Background:

• Dermal regeneration matrix (DRM) is safe and effective for acute hand burn management.
• A 2-stage DRM with split-thickness skin graft (STSG) is common; however, a 3-stage approach (allograft, DRM, STSG) is used at our institution.
• This study compares surgical and functional outcomes of 2-stage versus 3-stage DRM reconstruction for hand burns.

Purpose of the Study:

• To compare the surgical and functional outcomes of 2-stage DRM reconstruction versus a 3-stage reconstruction for hand burns.
• To evaluate the impact of a 3-stage approach on the need for repeat grafting and complication rates.
• To assess functional recovery using DASH scores in patients undergoing 2-stage versus 3-stage DRM reconstruction.

Main Methods:

• Retrospective cohort study of surgically managed hand burn patients from April 2009 to December 2022.
• Inclusion criteria: patients treated for hand burns during the study period.
• Data collected on surgical outcomes, complication rates, and functional outcomes (DASH scores).

Main Results:

• 183 patients (273 hands) were analyzed; 66.7% received 3-stage DRM, 20.9% received 2-stage DRM.
• The 3-stage DRM significantly reduced the odds of requiring repeat grafting (OR=0.03) and was linked to fewer complications and less need for delayed reconstruction.
• No significant difference in baseline or end-of-treatment DASH scores was observed between the 3-stage and 2-stage DRM groups.

Conclusions:

• A 3-stage DRM approach effectively reduces the need for repeat split-thickness skin grafting in hand burn management.
• This multi-stage strategy is particularly beneficial when autologous skin is scarce or in severe burn cases requiring multiple interventions.
• The 3-stage DRM approach achieves functional outcomes comparable to the 2-stage method, preserving the benefits of dermal regeneration matrix therapy.