Technology update Indications for the use of MatriDerm in the treatment of complex wounds
In a case reported by Cervelli et al,[11]
concurrent application of STSG and MatriDerm was found to be a simple, safe and economical in the treatment of diabetic foot ulcers. The report presented a 65-year- old male with a three-year history of infected diabetic ulcer (25 x 35mm2
Additionally, patient concordance with the device was reported to be excellent and the costs associated with its use were found to be lower compared with foam-based NPWT.
; 10mm deep) in his
foot. The patient was treated with MatriDerm and STSG as a one-step procedure on the wound bed following surgical debridement, complemented by antibiotic therapy. After a single treatment, the investigators found a reduction in the size of the ulcer 15 days postoperatively. Pain and exudate were also found to be reduced. In another case report, Wetzig et al[13] demonstrated the possibility of using STSG with MatriDerm on deep wounds with exposed tendons to achieve acceptable functional and cosmetic outcome. The report presented an 80-year-old male who had multiple co-morbidities (including diabetes) with a tendon-exposing defect on the dorsum of the hand resulting from micrographic-controlled tumour excision. The defect was closed by applying MatriDerm and STSG in a one-step procedure following surgical debridement and haemostasis. The wound achieved complete closure with a normal skin appearance six months postoperatively. The properties of MatriDerm were further investigated by Ryssel et al[16]
in more complex
cases such as necrotising fasciitis (NF). In their study, five patients who had full-thickness skin defects with exposed tendons or joint capsules due to NF were treated with a single-step application of MatriDerm and STSG. These patients, who would normally have undergone complex reconstructive surgery that might have included a free-flap, were either not keen on extensive flap surgery, or had unfavourable vascular preconditions. The investigators reported no reduction in the skin graft take rate. The healing time, however, might be considered to be prolonged compared to reconstructive flap surgery. More recently, Goutos and Ghosh[17]
have demonstrated the potential use of gauze-based negative pressure wound therapy (NPWT) as an adjunct to MatriDerm resurfacing. In the 10 patients studied (seven males and three females), vacuum therapy (as opposed to foam-based NPWT) was found to be effective in all cases for bolstering the one-step MatriDerm templates onto wounds, and contributed to excellent rates of epithelialisation (mean: 94%; range: 70–100%).
FUTURE RESEARCH In common with many other similar products, randomised controlled trials examining the effectiveness of MatriDerm are currently lacking, making it difficult to safely recommend its widespread use in clinical practice. The current evidence is mostly based on non-randomised prospective trials, retrospective reviews, small case series and isolated case reports. No trials are available at present that evaluate MatriDerm with an existing TEDC or a similar dressing/device. In addition to evaluating clinical components such as rate of healing and skin graft take, a carefully designed study to ascertain the clinical effectiveness of dermal templates in terms of the sensory recovery of the field, pigmentation and long-term skin quality will provide more robust information to recommend its use in a variety of challenging wounds. Tissue-engineered skin substitutes and TEDC
are seldom effective in sloughy and exudative wounds with unhealthy wound beds. Efficient wound care (wound debridement and exudate management), adequate rest, compression, pressure relief and skin care must be provided as clinically indicated. Novel treatment modalities such as TEDC should complement rather than replace the tenets of good, basic wound care.
ACKNOWLEDGEMENTS This article was prepared with the aid of sponsorship from Medskin Solutions/Dr Suwelack.
References
AUTHOR DETAILS Stuart Enoch, MBBS, PhD, PGCert (Med Sci), MRCSEdin, MRCS (Eng), Programme Director – Education and Research, Doctors Academy; Honorary Tutor in Wound Healing – University of Cardiff Lars-Peter Kamolz, MD, PhD, MSc, Professor and Head, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Austria
16. Ryssel H, Germann G, Czermak C, Kloeters O, Gazyakan E, Riedel K. MatriDerm® in depth-adjusted reconstruction of necrotising fasciitis defects. Burn 2010; 36(7): 1107–11.
17. Goutos I, Ghosh SJ. Gauze-based negative pressure wound therapy as an adjunct to collagen-elastin dermal template resurfacing. J Wound Care 2011; 20(2): 55–56, 58, 60.
www.woundsinternational.com
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Technology and product reviews
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