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

Dermal regeneration matrix (DRM) has been demonstrated to be safe and beneficial in improving functional outcomes for the management of acute hand burns. DRM followed by split thickness skin graft (STSG) allows for a 2-stage reconstruction for most operative hand burn injuries. Our site routinely implements a 3-stage approach: allograft in the first stage, DRM in the second stage, and STSG in the final stage. This study aims to compare the surgical and functional outcomes of 2-stage DRM reconstruction and 3-stage reconstruction.

A retrospective cohort study was conducted to review surgical and functional outcomes of patients treated for hand burns. All patients seen from April 2009 to December 2022 with hand burns, who were managed surgically, were considered for the study.

A total of 227 patients were treated for hand burns between 2009 and 2023. Out of these, 183 met the inclusion criteria. Most patients were male (72.9%, n = 129) and had burns covering an average of 19.2 ± 19.4% total body surface area, with the majority being full-thickness burns (84.2%, n = 154). Almost half of the patients (49.2%, n = 90) had bilateral hand burns, leading to a total of 273 hands treated. The treatments included a 3-stage DRM for 66.7% (n = 182), a 2-stage DRM for 20.9% (n = 23), direct grafting for 8.4% (n = 23), and skin substitutes only for 4.1% (n = 11). The 3-stage DRM significantly reduced the odds of requiring repeat grafting during acute management (odds ratio = 0.03) and was associated with lower complication rates and need for delayed reconstruction. Objective hand function examination showed no significant difference in baseline or end of treatment DASH scores between 3-stage and 2-stage DRM groups.

These data suggest a 3-stage approach reduced the need for repeat STSG. This approach may be especially useful when autologous skin is limited or if the patient requires multiple rounds of excision and grafting due to the nature and severity of the burn injury. Patients who received a 3-stage approach had comparable mean DASH scores when compared to patients who received a 2-stage approach, suggesting that a 3-stage approach does not diminish the functional benefits of DRM previously demonstrated in the literature.