D57. A Single Center 13-year Experience with a 3-stage Dermal Regeneration Matrix Approach to the Acute Management of Hand Burns

PURPOSE: Dermal regeneration matrix (DRM) followed by STSG allows for a two-stage reconstruction for most operative hand burn injuries. Our site routinely implements a 3-staged approach with cadaver allograft at the first stage. This study compares the outcomes of 2-staged and 3-staged reconstruction. METHODS: A retrospective study was conducted to review surgical and functional outcomes of patients treated for hand burns. All patients seen from April 2009 and December 2022 with hand burns, for who objective hand measurements were available, were considered for the study. RESULTS: 44 patients had objective hand measurements and were included in the study. Patients were followed for 22.0±25.0 months. Most burns were full thickness (97.7%, n=43) and involved 15.3±16.7% TBSA. Patients suffered thermal injuries (93.2%, n=41) and electrical burns (6.8%, n=3). Most cases (n=27) received a 3-staged approach with cadaver allograft at first stage, dermal regeneration matrix (DRM) at second stage, and split thickness skin graft (STSG) for final reconstruction. Fewer cases received a 2-staged approach with DRM and STSG (n=10). No 3-staged cases required repeat STSG, while 40% of 2-staged cases required repeat STSG. Repeat STSG in acute management was significantly associated with patients who received the 2-staged (p<0.01).There was no significant difference in mean baseline DASH scores for patients that received cadaveric allograft during acute management (46.5±22.3%) when compared to those who did not (48.7±22.5%) (p=0.8033). CONCLUSION: These data suggest a 3-stage approach may conserve autologous STSG without diminishing the functional benefits of DRM, with fewer instances of repeat grafting.