Addressing the Challenge of Complex Wound Defects: The Scope of a Dermal Matrix Editorial Summary Complex, full thickness soft tissue injuries pose a great challenge to every clinician. In patients where primary closure is not possible, other options need to be considered. Traditionally, small defects were covered using a split thickness skin graft (STSG) and larger defects were resurfaced using full thickness skin grafting (FTSG). STSG and FTSG alone can compromise the final functional and aesthetic outcome. Dermal templates improve the quality of the reconstruction. This article is an overview of the application and efficacy of a dermal substitute: MatriDerm® (Medskin Solutions Dr. Suwelack AG, Germany).
Introduction
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kin is a barrier from the external environment; this is its primary function. In clinical scenarios where there is a full thickness skin defect present, traditionally a full thickness skin graft (FTSG) or a flap was used for healing. However, these procedures sometimes come with complications, compromised outcomes, and the generation of donor site scars. Using a split thickness skin graft (STSG) alone however can contribute to scar contraction, contour defects, and functional deficits.1 Several dermal substitutes have been developed over the last decades, and more recently innovation in this area has led to the development of products that allow clinicians to consider long-term prognosis and aesthetic outcomes, as well as the priority of healing the wound.2,3
What Is a Dermal Substitute? Dermal substitutes are biomatrices that carry out the functions of the cutaneous dermal layer of skin by providing scaffolding and thereby contributing to the control of pain and scarring. This dermal architecture also facilitates tissue growth and wound healing.4 These substitutes have an integral role in reconstructing full thickness defects in the acute and chronic setting, and also reduce scarring. With concerns raised over the possibility of dermal substitutes potentially compromising skin grafts by acting as a barrier between the graft and the wound, many dermal substitutes have been developed with the intention of application as part of a two-step methodology;
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Wound Masterclass - Vol 1 - September 2022
the product is first applied to the wound in an initial procedure, and the skin graft is applied later in a second procedure.3 An ideal dermal substitute however gives the surgeon the possibility to apply the skin graft directly, without the need to wait for weeks, or in case a two-step procedure is needed already after a few days, due to the fast integration and vascularization of the dermal template.
What Is the ‘Ideal’ Dermal Substitute The role of the dermal substitute is essentially to replace the injured layers of skin, which can extend from superficial epidermis down to the deep dermal layer, sometimes a full thickness skin loss, and sometimes with exposed tendon or bone. Full thickness injury is defined as involving all the layers of the skin and is deficient in keratinocytes, stem cells and fibroblasts;3 therefore the role of an ‘ideal’ dermal substitute is one that can replace the deficient layers, accelerate vascularization and cell growth and minimise post-operative complications, and should have the following properties: • • • • • • •
Bioabsorbable Accelerate wound healing and wound closure Promote vascularization and cell growth Prevent infection Lead to regeneration of new skin Limit scar formation Lead to functional as well as aesthetic outcome
There is evidence for the use of MatriDerm® in a broad range of indications, as well as treating
Dr Ali Shahmoradi Global Medical Affairs Manager, MedSkin Solutions Dr. Suwelack AG Hamburg, Germany