Use of Hyaluronic Acid–based Biological Bilaminar Matrix in Wound Bed Preparation

A Case Series

Richard Simman, MD, FACS, FACCWS; Walid Mari, MD; Sara Younes, MD; Michael Wilson, MS


ePlasty. 2018;18(e10) 

In This Article

Abstract and Introduction


Objectives: To analyze the efficacy of a hyaluronic acid–based matrix in the treatment of lesions where the extracellular matrix was lost.

Methods: Prospective, noncomparative clinical case series.

Results: Twelve patients with 12 serious surgical wounds of different etiologies participated in this project. Many defects showed exposed muscle, tendons, and/or bone. After thorough debridement, a hyaluronic acid–based matrix, with a removable, semipermeable silicone top layer, was applied for the purpose of generating a neodermis. In a number of cases, the matrix was combined with negative pressure wound therapy. All wounds developed granulation tissue. Nine wounds were subsequently closed with a split-skin autograft. There was no graft failure. Three wounds healed by secondary intention. All wounds showed complete reepithelialization.

Discussion: Lesions with exposed tendon and bone are difficult to heal. Providing a granulation tissue through the use of an extracellular matrix in which cellular repopulation leads to the development of granulation tissue has been shown to be beneficial with regard to the speed and quality of healing. In this case series, the use of a hyaluronic acid–based matrix was shown to provide a granulation tissue and all lesions healed completely.

Conclusion: This case series shows a strong trend for Hyalomatrix to play an important role in supporting wound healing in complex, surgical wounds.


As a surgical rule and represented in the well-documented recommendations of staged wound healing,[1,2] removal of devitalized tissue is an essential part of wound treatment and the initiation of wound repair,[3–5] whether the necrosis is caused by thermal or mechanical injury, infection, or any other reason. Unless the lesion is small enough to allow for relatively rapid reepithelialization by secondary intention, the lesion then should be covered by an autograft such as a split-skin graft or a flap.

Deep wounds pose a problem with regard to graft take: although grafting directly on clean, healthy muscle is possible,[5] direct coverage of tendon and bone is difficult without the development of granulation tissue over these structures.[6] In addition, such practice may lead, upon healing, to a depression in the skin surface, which may be cosmetically undesirable.

Replacement of lost extracellular matrix (ECM) in deep wounds has been proven to be beneficial with regard to the development of granulation tissue and the quality and speed of healing.[7,8] Many matrices are now available, and all aim at replacing the lost ECM with a matrix that will allow and encourage the production of a "neodermis."[9–12]

Some of these products are based on esterified hyaluronan (also known as hyaluronic acid HA), which is a regular and abundant compound of the ECM and plays several roles in homeostasis and healing.[13–16] Hyalomatrix* (eHAM; Medline, Mundelein, Ill) is a biodegradable dermal matrix contact layer, made of Hyaff (Medline), an esterified form of HA. The dressing has a protective outer silicone layer. The matrix acts as a scaffold for the creation of a neodermis, which can be grafted upon after removal of the top layer. eHAM has been used successfully as an ECM in different types of wounds.

This retrospective case series describes the use of eHAM in subjects with full-thickness lesions of different etiology, but primarily because of serious soft-tissue infections, and presents 2 typical, complex cases.

*Hyalomatrix. In the European Union, the matrix is called Hyalomatrix PA.