Delayed autografting in the face and hands: The role of allografts in burn wound bed preparation.

INTRODUCTION

Burn injuries affecting specialised areas such as the face and hands require durable skin coverage and complete graft "take" to prevent scarring and functional impairment. Failure to achieve these outcomes can lead to long-term complications. This presentation aims to describe an approach of delayed autografting in these regions, following a "trial of allograft" to optimise wound bed preparation. We hypothesize that a trial of allograft prior to autografting improves graft take, and hence aesthetic and functional outcomes in specialised burn areas.

MATERIALS AND METHODS

Four patients with burns involving the hands ( = 3) and face ( = 2) were treated using allografts. The patients presented with TBSA burns of 60 %, 60 %, 55 %, and 2 %, respectively. In three cases, the primary indication for this approach was to prioritise life-saving coverage through the use of micrografts, while temporarily allografting the hands for three weeks. Skin exchange with sheet autografts was performed after re-excision of any non-viable areas, except in one patient who succumbed to pneumonia due to inhalation injuries. For facial burns, serial tangential excision was performed followed by allograft application to assess the viability of the wound bed, as indicated by their take.

RESULTS

Initial allograft take was 80 %. After re-preparation of non-take areas, autograft adherence reached 100 %. One patient expired before skin exchange could be performed.Two patients who successfully underwent skin exchange regained full ROM and independent ADLs. The facial burn patient achieved minimal scarring and full mimetic function, with preserved cosmetic subunits.

CONCLUSION

Delayed autografting of specialised areas facilitated optimal wound bed preparation, ensuring a 100 % take of the autograft.