Hyaluronic acid-based dermal substitute with stromal vascular fraction vs. partial thickness skin grafts for the treatment of intermediate-deep burns of the hand: a retrospective case-control study.

Deep intermediate burns of the hand are a challenge for both the functional and aesthetic result. In this study we compare the efficacy of early selective enzymatic escarolysis followed by the application of stromal vascular fraction (SVF) extracted from autologous adipose tissue on a dermal substitute scaffold (DS) versus reconstruction by partial thickness skin grafts (PTSG). We enrolled all patients admitted to our referral Burn Center from September 2020 to January 2022 with deep intermediate burns of the hands: clinical data were collected, then the first group of 4 patients were treated with PTSG surgical reconstruction, and the second group of 7 patients with DS+SVF. Subsequently, the morpho-functional and aesthetic outcome (with quickDASH and POSAS questionnaires), the healing time and the number of accesses in the operating room were evaluated. A total of 11 patients and 18 hands were treated in the period considered for the study. The mean TBSA was 22.5±15.2% in Group 1, 23.6±13.6% in Group 2; the mean age in Group 1 was 47.3±17.6 yo, in Group 2 51.4±16.3 yo. The mean follow up was 10±2.5 months. At six months qDASH and POSAS in Group 1 were: qDASH 53.4±2.5; OSAS 53.3±5.1; POSAS 51.3±4.3; in Group 2: qDASH 20.8±7.8; OSAS 19.7±8.1; POSAS 17.4±7.8. Group 1 had an average healing time of 75±15 days vs 20.4±9.3 days for Group 2, and 2.5±0.5vs1 accesses in the operating room. SVF combined with hyaluronic acid-based dermal substitute demonstrated a better morpho-functional and aesthetic outcome, and reduced patient healing time and accesses in the operating room compared to surgical partial thickness skin graft reconstruction in the treatment of intermediate-deep burns of the hand.