Technology and product reviews
dorsum of the hand. In this prospective study, 18 patients (age 45.1±17.4 years, 43.8±11.8% TBSA) with extensive burn wounds on the dorsum of both hands received an STSG sheet alone on one hand or an STSG sheet with MatriDerm on the other as a one-step procedure. Simultaneous application of STSG and MatriDerm did not have any detrimental
Case Studies
Despite successful defect coverage by complex skin flaps, large and deep wounds are particularly susceptible to surgical revision because of contour and scar deformities. The application of the dermal template MatriDerm in patients with problematic wounds represents an innovative reconstruction method, from initial coverage to scar development.
Case 1 A 70-year-old male pensioner suffered an ischaemic stroke at home. He was found four days later lying on the floor unable to move and had developed large pressure ulcers of the left thorax and the lateral side of the left knee. After cardiopulmonary stabilisation at the intensive care unit, operative debridement of the necrotic tissue exposed both knee capsule and rib cartilage.
Figs 1 and 2 show the left knee and left side of the thorax one week after the use of initial debridement and NPWT to obtain proper granulation of the wound beds. Defect coverage was performed with 1mm MatriDerm and unmeshed split skin grafts. Negative pressure wound therapy (NPWT) was then used to encourage optimum fixation of the MatriDerm and the split- thickness skin grafts and this was discontinued after one further week.
Beside optimal graft take, MatriDerm provided reliable defect coverage [Figs 3 and 4].
effect in the graft take compared to STSG alone (p>0.05). In addition, VSS analysis demonstrated a significant increase in skin quality in the group with MatriDerm (p=0.02) compared to the control group. The range of motion measured by Finger-Tip-Palmar-Crease- Distance (FPD) was found to be significantly improved in the substituted group (p=0.04).
Fig 1
Fig 2
Fig 3
Fig 4
Case 2 This 71-year-old pensioner suffered a degloving injury of the left lower leg and foot [Fig 1]. After operative debridement, there was significant soft tissue loss with visible tendons and periostal structures of the medial ankle [Fig 2]. Angiography showed that the lower leg and foot were only being nourished by a arteriosclerotic tibialis posterior artery.
References
14. Bloemen MC, van Leeuwen MC, van Vucht NE, van Zuijen PP,
Middelkoop E. Dermal substitution in acute burns and reconstructive surgery. A 12-year follow-up.
Plast Reconstr Surg 2010; 125(5): 1450-59.
15. Ryssel H. Andreas Radu C,
Germann G, Otte M, Gazyakan E. Single-stage MatriDerm and skin grafting as an alternative
reconstruction in high-voltage injuries. Int Wound J 2010; Oct;7(5):385-92
Fig 1 Fig 2 Fig 3 Fig 4
These case studies were prepared by M Öhlbauer and B Wallner of the Department of Plastic, Hand and Reconstructive Microsurgery, and Ph Rapp and M Militz of the Department of Septic Surgery, BG Trauma Center, Murnau, Germany.
Defect coverage was performed using 1mm MatriDerm and unmeshed split skin grafts in combination with one week of NPWT to fix the grafts [Fig 3]. Two years after the accident the patient was able to wear normal shoes and clinical gait analysis demonstrated a perfect functional outcome [Fig 4].
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