To investigate the clinical application effect of artificial dermis combined with autologous blade thick scalp in repairing limb joint scar contracture after burn in children.

A retrospective study was conducted on 23 children with scar contracture after burn in the joint of the limbs in Department of Burns and Plastic Surgery, Beijing Fengtai Youanmen Hospital from March 2017 to March 2020. Routine preoperative laboratory tests and examinations were completed after the patients were admitted to hospital. Scar tissue was removed in the first stage of surgery to correct joint contracture deformity. Artificial dermis of the same size as the wound area were taken to perforate and cover the wound, and the silver-containing antibacterial dressings, gauze pads, medical cotton pads, etc. were used to properly pressurize and plaster to fix the joints. Antibiotics were given to prevent infection during perioperative period. Dressing change was started 1 week after operation to observe the vascularization of the artificial dermis, and the dressing was changed once every 2 to 3 days. Two weeks after the operation, the artificial dermis was vascularized, and dermal tissue was found in the wound base. The second-stage operation was performed to transplant the blade thick scalp of the same size as the wound (thickness about 0.2-0.3 mm) onto the wound, fixed it with skin nails, and bandaged the donor and recipient areas with silver-containing antibacterial dressings, gauze pads, medical cotton pads, etc. The dressing was changed at the receiving area 3 days after skin grafting, and the dressing was changed once every 2 to 3 days; the outer dressing was removed from the donor area 5 days after the operation, and the inner oily silver dressing was retained, and kept dry until it fell off and healed naturally. The vascularization of the artificial dermis and the survival of the razor-edge thick scalp were observed after surgery. The outpatient or network follow-up was performed to observe the rupture, color, texture, scar growth and joint function of the grafted skin area in the long term.

After the first operation, the artificial dermis was vascularized in all the other 21 cases, except 2 cases which were successfully vascularized by covering the artificial dermis again after the second debridement due to the loss or dissolution of the artificial dermis due to hematoma or infection complications. After the second stage of skin grafting, all the 23 patients with blade thick scalp survived. After 6 to 12 months of outpatient or network follow-up, the grafts showed no rupture, good color and texture, no scar hyperplasia, and satisfactory recovery of joint function.

Artificial dermis combined with autologous blade thick scalp to repair limb joint scar contracture after burn in children is less traumatic than skin flaps or full-thickness skins, and the effect is satisfactory.