Natural Expansion of Artificial Dermal Template by Successful Full-Term Pregnancy

Abstract

Extensive postburn scars of the trunk may cause breathing difficulty and, in female patients of reproductive age, render future pregnancy a serious reconstructive goal. Scar excision and skin grafting with or without artificial dermal templates is the current preferred management. A patient who underwent staged extensive grafting of the abdominal wall by dermal regeneration template and completed a full-term successful pregnancy is presented here. Although tissue expanders have been used to expand artificial dermal templates, natural expansion by pregnancy has not been previously documented. A 30-year-old woman with extensive chest and abdominal wall, bilateral gluteal and breast scars after burns sustained at childhood presented with difficulty in deep breathing. Abdominal scar tissue was excised and the abdominal wall was reconstructed by dermal regeneration template and autologous thin split-thickness skin graft in two stages. Six months postoperatively, spirometric values were improved by 15%, while 1 year later the patient completed successfully a full-term pregnancy. Reconstruction of extensive abdominal postburn scars by dermal regeneration template improves breathing by increasing elasticity and compliance of the reconstructed area. In female patients, the template can be extensively and naturally expanded by the gradually growing uterus, allowing for full-term pregnancy.

Protocol of surgical indications for scar contracture release before childbirth: Women with severe abdominal scars after burn injuries

“…However, the problem of postoperative contracture cannot be avoided. Kakagia et al [9] performed a two-stage procedure using artificial dermal tem plate and thin split-thickness skin graft, enabling full-term pregnancy. Although this procedure requires two surgeries and a longer treatment period, one should consider the use of artificial dermis.…”