## 2 Material and Methods
The follow up of the patient at 11 years after the surgery showed the stability of the Integra matrix on the neck with the recovery of the pigmentation, and soft, good quality, and mobile skin without any sign of keloid (Figure 1F). Figure 1: _Cont._  
Case 2  
A 43-year-old female patient was admitted in our burn unit with 64% burned surface, chemical burns IIIrd degree (face, neck, anterior thorax, abdomen, upper and lower limbs). During three months, the scar was excised and grafted with autografts. One year after complete healing of burn lesions, the patient returned in our clinic with hypertrophic scars and contractures involving the right side of the neck and face, arms, axillae, right palm, abdomen and lower limbs. We decided to use Integra to improve contractures and scars for the right side of the neck and for the right palm. (Figure 2A) The scar tissue and contractures were excised and replaced with Integra (Figure 2B). Twenty days after surgery, the patient developed Staphylococcus aureus infection, treated for 5 days with Ciprofloxacin twice a day. One week later, the silicone layer was replaced with an epidermal autograft and after seven days, and the patient was discharged with healed grafted and donor areas (Figure 2C). Six months later, the skin was soft and easy to pinch, and the mobility of fingers was improved. Case 3  
A 21-year-old girl was admitted to our emergency burn unit with post-burn hypertrophic scars and contractures involving the face and the neck. The patient sustained scalds 10 years ago affecting the face, neck, and anterior trunk and hands about 25% body surface. She was treated by skin grafting of the IInd b and IIIrd degree burn areas. Three years later, she presented in our clinic with unsightly scars, contracture, and restricted neck movements (Figure 3A,B). We also chose Integra to improve contractures and scars. Nine months later, the skin was soft, easy to pinch, the skin colour was closer to normal and the neck movements were in the normal limits (Figure 3C,D). Figure 1: Case 1. A twenty-six years old female patient with 58% burned surface, flame burn (face, neck, anterior and posterior thorax, upper limbs, both axillae, lower limbs): (**A**) Aspect of the burn neck scar after two years-contractures, keloids and hypertrophic scars affecting the burned areas as well as the grafted parts; (**B**) image of the neck, after excision of the scars and contracted tissue; (**C**) final aspect of the neck seven days after application of epidermal autograft, frontal view; (**D**) final aspect of the neck seven days after application of epidermal autograft, frontal view; (**E**) Final aspect of the neck nine months after surgery. (**F**) Result at 11 years after surgery with soft, pliable skin more alike to normal skin. Figure 3: Case 3. A 21-year-old girl that suffered in her childhood, ten years ago a thermal burn by hot liquid IIndb–IIIrd degree on 25% burned surface (neck, anterior thorax, upper limbs): (**A**) Aspect of the neck scar prior to Integra reconstruction—frontal view; (**B**) aspect of the neck scar prior to Integra reconstruction—lateral view (**C**) neck skin reconstruction with Integra, 9 months later-frontal view (**D**) neck skin reconstruction with Integra, after 9 months—lateral view. Figure 2: Case 2. A 43-year-old female patient with a 64% burned surface, IIIrd degree after chemical burn (face, neck, anterior thorax, abdomen, upper and lower limbs): (**A**) Hypertrophic scars and contractures involving the right side of the neck, one year after complete healing of burn lesions; (**B**) image of the neck skin, six days after reconstruction with Integra; (**C**) final aspect of the neck, seven days after the second stage of reconstruction (after covering with epidermal autograft). Case 4  
A 50-year-old patient admitted with post-burn hypertrophic scars and contractures of the neck and anterior thorax, after repeated surgical procedures (skin grafting, tissue expansion) (Figure 4A).