**2.3 Clinical applications of skin substitutes in secondary burn wound resurfacing**

The long-term outcome of scarring for survivors of large burn injuries is unpredictable. Skin grafted areas can form unstable pathological scars resulting in itch, pain and reduced function, particularly if the burn scar cross joints. Additionally, the aesthetic appearance is less than ideal.

A method to treat this involves scar excision and re-surfacing using dermal substitutes and split skin grafting. The introduction of skin substitute is beneficial in two ways. Firstly, the secondary contracture associated with using split skin grafts is reduced when using a dermal interface. Secondly the scar quality and pliability is improved when split skin grafting is used in conjunction with skin grafting. Frequently used skin substitutes in secondary burn wound reconstruction include:


The surgical technique for scar excision remains constant but the choice of dermal substitute is dependent upon surgeon preference, size of defect and patient choice.
