Technology update Indications for the use of MatriDerm in the treatment of complex wounds
Sheets of 2mm thickness are recommended
for two-step repairs, with a time interval of seven days to allow for vascularisation of the matrix before the transplantation of STSG. However, a one-step procedure is feasible in the acute and reconstruction phases, for example following burn injuries. Approximately 10 days after dressing removal,
physiotherapy can be initiated. The skin graft take rate does not differ significantly compared with a normally applied STSG and the quality of the resulting scars is reported to be superior compared with skin grafting alone[9]
.
There are reports claiming that dermal substitutes using one-step grafting procedures might affect the survival of the overlying epidermal transplant, and it has been postulated that the increased diffusion distance for nutrients and oxygen to the autograft after inter-positioning of the substitute can reduce chances of the graft’s survival[10]
.
MatriDerm is also a feasible one-stage procedure in critical care patients. Moreover, MatriDerm has haemostatic
properties that reduce the risk of split-skin sub- graft haematoma[11]
. The fact that MatriDerm
does not contain any chemical crosslinking results in a matrix that can provide effective biocompatibility[12]
.
EVIDENCE There is evidence for the use of MatriDerm in a broad range of indications, eg full-thickness wounds, trauma and skin cancer excisions [11,13] MatriDerm has also been found to be
effective in both the acute and reconstructive phases of hand and joint injuries due to flame burns. The first clinical reports were published by Haslik et al[5]
who performed
early debridement and immediate grafting of unmeshed STSG with MatriDerm on 10 patients as a one-step procedure. An overall skin graft take rate of 97% was observed 14 days postoperatively and after three months pliability of the grafted area was found to be excellent with a mean Vancouver Skin Score (VSS) of 3.2+/-1.2. A full range of motion was achieved in all hands and no blisters or hypertrophic scars were noticed in any of these wounds. This pilot study provided the initial evidence for the effectiveness of MatriDerm in hand burns and consequently resulted in MatriDerm being considered as an
effective treatment modality in such injuries. More recently, Haslik et al[10]
reported the
long-term results of applying unmeshed STSG with MatriDerm in 17 patients. A skin graft take rate of 96% was observed and long-term follow-up revealed an overall VSS of 1.7. No limitations in hand function were observed and DASH-score (disability of arm, shoulder and hand) analysis revealed excellent hand function in patients who underwent debridement and reconstruction following burn injury (15.6 DASH score). Good hand function (27.2 DASH score) and minimal donor site morbidity was also found in the forearms of patients who underwent a radial forearm flap harvest. Bloemen et al[14]
reported the results of a . However, in many studies
employing MatriDerm and sheet autografts, this problem was not encountered[5]
12-year prospective randomised follow-up on 46 patients who were treated with STSG or STSG plus MatriDerm for acute burns and reconstructive surgery. Intra-individual comparison was also carried out between scars from patients treated with STSG alone and those treated with STSG and MatriDerm. In reconstructive sites, the surface roughness parameter was significantly improved in the MatriDerm group. Subjective assessment in acute and
.
reconstructive burn scars showed several statistically significant differences in favour of the MatriDerm group, such as pliability, relief, pigmentation and the quality of the healed wound. Elasticity measurements in acute burn patients showed higher scores for substituted scars, although the difference was not statistically significant. For the subcategory of scars treated with a largely expanded meshed skin graft, a significantly higher elasticity was found for the substituted site. In a prospective intra-individual comparative study by Ryssel et al[9]
comprising 10 patients
with severe burns (age 49.5 ± 16.2 years; TBSA 45.6 ± 14.5%), 20 wounds were treated with either STSG alone or simultaneous application of MatriDerm and STSG after appropriate excision of the burn wound. Results showed that the take rate of the graft was not altered by simultaneous application of the dermal matrix (p = 0.015). After three to four months the VSS demonstrated a significant increase in elasticity in the MatriDerm group (p = 0.04) as compared with the non-substituted group who received unmeshed autograft. However, a significant difference was not found between this and the meshed autograft group (p = 0.24). Subsequently, Ryssel et al[15]
evaluated the effectiveness of MatriDerm in burns on the
www.woundsinternational.com 39 References
9. Ryssel H, Gazyakan E, Germann G, Öhlbauer M. The use of MatriDerm® in early excision and simultaneous autologous skin grafting in burns — a pilot study. Burns 2008; 34 (1): 93–97.
10. Haslik W, Lumenta DB, Kamolz LP, Frey M. The use of a collagen– elastin matrix as dermal regeneration template for the treatment of full-thickness skin defects. Adv Wound Care 2010; 1: 438–44.
11. Cervelli V, Lucarini L, Cerretani C, et al. The use of MatriDerm and autologous skin grafting in the treatment of diabetic ulcers: a case report. Int Wound J 2010; 7(4): 291–96.
12. Kolokythas P, Aust MC, Vogt PM, Paulsen F. Dermal substitute with the collagen-elastin matrix MatriDerm in burn injuries: a comprehensive review. 2008; Handchir Mikrochir Plast Chir 40(6): 367–71.
13. Wetzig T, Gebhardt c, Simon JC. New Indications for artificial Collagen-Elastin Matrices? Covering Exposed Tendons. Dermatology 2009; 219(3): 272–3
Technology and product reviews
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