Dermal Regeneration Matrix in the Treatment of Acute Complex Wounds

Daniel Francisco Mello, PhD

Disclosures

Wounds. 2022;34(6):154-158. 

In This Article

Abstract and Introduction

Abstract

Introduction: Dermal regeneration matrices (DRMs) represent a significant advance in wound treatment, but their use remains limited because of high associated costs. Used correctly, DRMs help improve aesthetic and functional results of skin-grafted areas.

Objective: This case series reports the use of a DRM of 1-mm and 2-mm thickness in the management of acute complex wounds.

Materials and Methods: This is a retrospective analysis of a cohort of patients treated between 2015 and 2018. Complex wounds were defined as those with extensive loss of skin and subcutaneous tissue, or as those in critical areas, that required sequential and specialized treatment. Management of acute wounds involved debridement of devitalized tissue, wound bed preparation, DRM implantation, and split-thickness skin grafting (STSG). Negative pressure wound therapy (NPWT) was used in all cases preoperatively, after DRM implantation, and after STSG. Results of integration of DRM and skin grafts were subjectively evaluated. The Vancouver Scar Scale was used to evaluate results 12 months postoperatively.

Results: Traumatic injuries were the most common etiology, and the extension of the treated wounds varied between 4 cm × 5 cm to 42 cm × 28 cm, in the greatest dimensions. A 2-mm–thick matrix was used in 14 cases, with skin grafting after 7 to 9 days. In 6 cases, a 1-mm–thick matrix was used, immediately followed by skin grafting. Negative pressure wound therapy was used in all cases. Dermal regeneration matrices and skin graft integration rates of almost 100% were achieved in all cases. No complications occurred.

Conclusions: The results showed use of DRM and NPWT was a good reconstructive option in the management of acute complex wounds that required STSG. With proper patient selection, such treatment is an important tool in the armamentarium of reconstructive procedures.

Introduction

The advent of dermal regeneration matrices (DRMs) was a major advancement in wound treatment. These products were initially used in the management of burn sequelae, and the indication for use was later expanded to other types of injuries, both acute and chronic.

Treatment of patients with complex wounds has changed over time from a simple survival and decreased morbidity to an additional emphasis on functionality and aesthetics.[1–4] Split-thickness skin grafting (STSG) remains the treatment of choice for covering extensive raw areas, even though aesthetic and even functional results may be limited.[2,3,5–8] The formation of hypertrophic scar tissue with limited elasticity after STSG may result in restricted joint mobility.[2,3,5–8]

The collaboration of surgeons and basic scientists has resulted in the development of tissue engineering alternatives and synthetic products to manage full-thickness wounds based on the principle of substitution by similar tissues.[5,9–11] Unfortunately, use of DRMs remains limited, even in the supplementary public health system of Brazil, because of the high costs. Dermal regeneration matrices are available in the Brazilian public health system for specific use in the management of burn sequelae.

This case series reports the use of a DRM either 1-mm or 2-mm thick, in a 1-step and 2-step approach, respectively, for the management of acute complex wounds in a private hospital.

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