## 3 Results  
For all the 11 patients with post-burn neck contracture and hypertrophic scars, the intake of the Integra dermal regeneration template was 100%, even if one patient developed a minor Staphylococcus aureus infection treated with antibiotics for 5 days. The epidermal autograft showed no signs of infection or losses. The mean follow-up period was approximately 18 months. We evaluated the aesthetics of the scars (vascularization, thickness, elasticity, and pigmentation) as well as functional results (Table 2). The functional outcome was evaluated after surgical procedures and functional recovery and relied mainly on the analysis of cervical extension angle value (mento-hyoido-sternal); this angle is under normal circumstances a maximum of 135\({}^{\circ}\). An excellent result was considered if the cervical extension angle has a value of \(115\pm 20^{\circ}\), a good result is considered when a cervical extension angle with a value of \(90\pm 5^{\circ}\), and a poor outcome if a neck with an extension angle of less than 85\({}^{\circ}\) (Table 3). Figure 4: Case 4. A 50-year-old female patient suffered eleven years ago a 30% burned surface, flame burn, IInd-IIIrd degree (cervical region, anterior thorax, upper limbs): (**A**) Image of neck scar prior reconstruction with Integra; (**B**) image of the neck, 10 days after reconstruction with Integra; (**C**) skin neck reconstruction with Integra, after 3 months, frontal view; (**D**) skin neck reconstruction with Integra, after 3 months, lateral view. and neck contractures are the most difficult sites to treat. All the techniques we can use sometimes give unsatisfactory results. Z-plasties, split-thickness skin grafts, and full-thickness skin grafts often heal with retraction and contractures. Local flaps, if they are available, can be bulky, cover only limited areas, and may necessitate revision surgery [28; 29]. Because skin grafts do not bring a sufficient amount of dermis, skin dermis substituents were a good alternative. A type of these skin dermis substituents is Integra dermal template. Integra template was originally designed for immediate coverage of burn injuries, because a permanent dermis could rapidly be obtained [30; 31]. It was noted, however, that the newly-created skin showed less or no tendency to hypertrophic scarring, keloid formation, or contracture, because no granulation or scar tissue was formed, resulting in superior function, cosmetics, and ultimately eliminating the need for scar treatment and pressure therapy. Anatomical sites such as the face and neck are likely to develop contraction and hypertrophic scar problems after conventional skin grafting-thus, Integra might be a reconstructive option. If in 1996 U.S. Food and Drug Administration (FDA) (within U.S. Department of Health and Human Services) approved the use of Integra for treatment of life-threatening burn injuries, it took 8 years for FDA to approve this device for the reconstruction of scar contractures. After 2006, there were several studies for using Integra for the coverage of tendons, joints, bones, and urinary bladder [32; 33; 34]. In the beginning, [PERSON] et al. [29] used Integra in patients with major burns, and after that, its application has been expanded in reconstructive surgery for hypertrophic scars, keloids, and contractures. In 1990, [PERSON] et al. [31] examined the histologic phases of wound healing in sites treated with Integra artificial skin and observed invasion of the Integra network by macrophages, lymphocytes, the formation of granulation tissue, neovascularization, and the formation of a neodermis with no adnexa or nerve endings. It was noticed that there was the minimal immune response to the bovine collagen and other components of Integra which did not influence the healing. Integra was used for reconstruction of defects created by excision of giant hair nevi, for the reconstruction of acute and chronic wounds, to protect exposed tendons, joints, and bones and to correct volume defects in rhinoplasty.