## 2 Material and Methods  
In our clinic, we used collagen-glycosaminoglycan biodegradable matrix (Integra(r) Integra Lifesciences Corporation, Plainsboro, NJ, USA) for the first time in September 2009. Between September 2009 and November 2012, 11 patients ranging in age from 21 to 50 years (mean 34,3) with hypertrophic scars and retractions on the neck underwent reconstructive procedures with the Integra dermal regeneration template. Most of the patients were female (81.8%). The time between the burns and reconstruction ranged from one to eleven years (mean period was three years and five months). Most of the cases had burn scars localised on the anterior cervical region combined with retractile scars on the chin and of the body on the mandible (72.7%). More than half of patients underwent other reconstructive procedures before the Integra application. The average dimension of the remaining defect after scars excision was 140 mm/130 mm (Table 1). The patients were admitted one day before surgery, and basic lab tests were performed. The patients were functionally evaluated before reconstruction with Integra analysing mentocervical angle. We consider mentocervical angle the angle formed by a line that is tangential to the submental point-from the chin to the subcervical region, and another tangential to the neck at the subcervical region intersection-the lowest point between the submental area and the neck. The scar tissue was washed before surgery with Betadine soap (Egis Pharmaceuticals PLC, Budapest, Hungary under licence MundipharmaAG, Basel, Switzerland) and 0.9% saline solution (Hemofarm A.D., Vrsac, Srbija). Under general anaesthesia, the surgical procedures consisted of two stages. In the first procedure, scars were excised until healthy tissue was well-vascularised. After excision, the defect was 25-30% higher than the initial scar size. Integra was rinsed three times in 0.9% saline solution and immersed for 10-15 min. After careful haemostasis, we applied Integra non-meshed tailored to fit the wound with the silicone part upside and we secured in place with staples. The most common option for dressing the wound was bolstered dressing, first applying a thick film of calendula ointment Epitelin (Aliphia, Timisoara Romania) as a non-adherent occlusive layer, on top Betadine soaked gauze and bandages to the edge [24]. The neck movements were restricted using a soft cervical collar. The next day, the wound was checked for any hematoma or serous collection. In the first week, the wound was inspected regularly every two days, and after that twice a week. Nine days after surgery, we saw the first signs of neodermis formation. Large spectrum antibiotics were being used for the first two weeks. Three weeks later, the second stage of the procedure was performed. The silicone layer was removed carefully with blunt instruments. The new dermal layer was debrided using a scalpel, excising the excess granular tissue, and then it was cleaned with a sterile brush. The remaining tissue was inspected in order to avoid any bleeding. The donor site for epidermal autograft was disinfected and infiltrated with a saline solution. The graft was harvested from posterior thorax with 0.10-0.15 mm thickness. After expansion, the graft was stapled and dressed with bulky bandages. The wound was dressed for ten days, and after that the patients started application moisturizing and healing ointments; Contractubex (Merz Pharmaceuticals GmbH, Frankfurt am Main, Germany), Cimeosil (Implantech Associates Inc, Ventura, CA, USA), Stratamed (Stratharma AG, Basel, Switzerland) or any greasy ointment applied twice a day) for 6-9 months. Postoperative follow-up was 12-24 months. Below we present 4 cases more meaningful from the 11 studied. Case 1  
A 26-year-old patient was admitted in our emergency burn unit with 58% burned surface, flame burns, 40% was IIIrd degree (face, neck, anterior and posterior thorax, upper limbs, both axillae, lower limbs).