This page contains a Flash digital edition of a book.
Technology update Indications for the use of MatriDerm in the treatment of complex wounds


T E C H N O L O G Y U P D A T E :


Indications for the use of MatriDerm® in the treatment of complex wounds


Until recently, the gold standard treatment for covering full-thickness skin defects that required surgery was the use of a full-thickness skin graft in small defects and split-thickness skin grafts in larger instances. The use of full-thickness skin grafts is limited due to the size and availability of suitable donor sites. The use of split-thickness skin grafts can result in complications such as hypertrophic scarring, keloids or disabling contractures especially across joint surfaces. This has led to the development of dermal templates in order to improve the reconstruction of the dermis, which is very important for the quality and functionality of the reconstructed skin. This paper reviews the relevant aspects of wound healing and summarises the efficacy of an engineered dermal template called MatriDerm® (Medskin Solutions/Dr Suwelack) in a variety of acute and reconstructive wounds.


INTRODUCTION Recently the emphasis in managing full- thickness defects has shifted from merely reducing morbidity and achieving satisfactory survival to enhancing the long-term prognosis, function and aesthesis of healed wounds[1] The gold standard for the coverage of these


.


wounds was the use of autologous skin in the form of split-thickness skin grafts (STSG). However, the primary problem with this technique is a shortage of available autologous donor sites, for example in a patient with a 70% total body surface area (TBSA) burn. The other impediment is the poor skin


quality, altered sensation and variable pigmentation that often results at both the recipient and donor sites following skin grafting[2]


. In certain instances, disfiguring


hypertrophic scars, keloids or disabling contractures across joint surfaces can present patients and clinicians with substantial problems, such as adhesion (missing ‘gliding’ layer) and limited 'take rate' over tendons. Although full-thickness skin grafting


(FTSG) leads to less scarring, it can only be performed if the injured area is small[3]


its widespread use is limited by donor site availability.


. Thus,


Recently, advances in molecular biology and tissue engineering has resulted in the development of a number of dermal substitutes with the aim of improving skin quality and, thereby, functional and aesthetic outcomes.


Dermal substitutes Dermal equivalents have been developed to serve as a template for dermal repair and to improve overall wound healing by increasing the elasticity and pliability of the reconstructed skin. These dermal substitutes can help to minimise scar contraction and optimise the quality of the grafted area. However, since dermal substitutes may impede vascular ingrowth and hamper the diffusion of nutrients by increasing the distance between wound bed and the skin graft[4]


, it has been suggested that they could


place the overlying skin graft at risk. In order to avoid this, most dermal substitutes require a two-step approach to aid dermal vascularisation and avoid epidermal necrosis: n One operation to initially place the dermal substitute


n A second to place an STSG over the dermis. www.woundsinternational.com 34 35


Author: Stuart Enoch Lars-Peter Kamolz


Useful links and further reading


Advances in tissue-engineered skin substitutes


Acellular matrices for the treatment of wounds – an international review


References


1. Halim AS, Khoo TL, Yussof SJM. Biologic and synthetic skin substitutes: An overview. Indian J Plast Surg 2010; 43(Suppl): S23– S28.


2. Holavanahalli RK, Helm PA, Kowalske KJ. Long-term outcomes in patients surviving large burns: the skin. J Burn Care Res 2010; 31(4): 631–39.


Technology and product reviews


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57