Full-thickness burns across joints: results of coverage with acellular dermal matrix and thin autograft

The use of acellular dermal matrix and thin autograft to graft full-thickness burns over elbow and knee joints is evaluated. The percent of graft adherence, joint range of motion, and scar quality, as evaluated by the Vancouver scale, was noted for ten joints in eight patients following grafting. Graft adherence ranged from 75–100% at 7 days postoperatively. All patients maintained full elbow range of motion at long-term follow-up (average 4 months). Vancouver scales ranged from 3–4.5 as opposed to 4.5–8 for adjacent areas of conventional split-thickness skin grafts, the lower scores more closely approximating normal skin. Complete healing was demonstrated with maintenance of full range of motion and acceptable scar quality. The use of thinner split-thickness skin grafts would be expected to reduce donor-site morbidity, and the ability to re-harvest donor sites may be enhanced in patients with large surface area burns. Further follow-up of these patients is needed to evaluate the need for future reconstructive procedures.