To investigate the efficacy of acellular allogeneic dermis combined with autologous split-thickness skin graft in the repair of joint scar contracture after extensive burn.

From April 2017 to April 2020, 12 patients with joint scar contracture after extensive burn were selected in the Department of Burn and Gutaneous Surgery, First Affiliated Hospital of Air Force Military Medical University, including 9 males and 3 females, aged 23.0-67.0 years, with burn area ranging from 70.0%-95.0% total body surface area (TBSA). After the patients were admitted to the hospital and the relevant preoperative examination were completed, the site of surgical resection was determined, the stage I joint scar release was performed, and the joint scar with limited function was completely removed to restore its maximum functional position. The wound area after scar resection was 10.0 cm×5.0 cm-20.0 cm×15.0 cm. Acellular allogeneic dermis was used to cover the wound. Stage Ⅱ operation was performed after 7 days of closed negative pressure suction, autologous split-thickness skin was covered on the acellular allogeneic dermis. The wound was sutured and fixed, closed negative pressure suction was performed. The survival of skin graft was observed 7 days after surgery. Six months after wound healing, according to the evaluation standard of joint motion function in Practical Burn Rehabilitation Therapy, the range of motion of the joint was measured with a protractor, and the muscle strength, sensation, appearance, residual symptoms, joint area function and the appearance of the donor and recipient area of the affected limb were observed. Six months after wound healing, the clinical efficacy was evaluated according to the patient′s situation, and the satisfaction of patients was evaluated by self-made appearance satisfaction rating scale.

Seven days after surgery, all the skin grafts of 10 patients survived, and 2 patients had residual wounds in the skin graft area, which healed within 1 month after dressing change. Postoperative follow-up was 6-24 months, with an average follow-up of 12 months. Six months after wound healing, the maximum range of motion was 130° elbow flexion, 0 extension, 60° wrist palmar flexion, 65° dorsiflexion, 25° ulnar deviation and 20° radial deviation in 12 patients. The muscle strength of the affected limb was normal, the feeling was good, the appearance was greatly improved, the function of the joint area was significantly improved, the skin texture of the recipient area was soft, the color was similar to the surrounding normal skin, and the hair development in the donor area was not abnormal for all patients. Six months after wound healing, 10 patients were cured and 2 were effective; and 10 patients were very satisfied and 2 were satisfied.

Repair of joint scar contracture after extensive burn with acellular allogeneic dermis and autologous split-thickness skin graft has solved the problem of insufficient autologous inter-mediate thickness skin source, with good postoperative effect and worth being popularized.