Split-Thickness Skin Grafting with Meshed Matriderm(R) in Burn Wound Management

PURPOSE: Skin graft is the gold standard surgical treatment in burn wound management. But it has functional and aesthetic limitations, such as burn scar contracture, low quality of the grafted skin, unnatural looking skin, loss of skin elasticity, especially in extensive deep burn wound which has tendon or bone exposed. The authors used Matriderm(R), a dermal analogue, with split-thickness skin graft simultaneously in burn wound and evaluate the effectiveness of Matriderm(R) for treatment of burn wounds, in comparison with the skin graft only. METHODS: 40 burn patients with skin graft were included in this study. Patients were selected with their consent for inclusion in an experimental group and a control group. Patients in the experimental group received a meshed Matriderm(R) appliance and a split-thickness skin graft, while those in the control group received only a split-thickness skin graft. Time to complete epithelization, rates of skin graft taken areas, Vancouver scar scale assessment, skin elasticity was evaluated. RESULTS: A better scores of Vancouver scar scale assessment (3 points) were observed in the experimental group with the control group (6 points) with statistical significance (P<0.05). A higher elasticity ratio of the affected side to the non-affected side was observed in the experimental group, compared with the control group (P<0.05), and a similar time to complete epithelization and rates of skin graft taken areas were observed in the experimental group when compared with the control group. CONCLUSION: Meshed Matriderm(R) enables effective healing and improves functional and aesthetic results in split thickness skin graft treatment of burn wounds.

Clinical Experience of Matriderm(R) with Autologous Skin Graft in Full Thickness Burns

PURPOSE: The various skin substitutes for the reconstruction of full thickness skin defects after burn or excision of burn scars have been reported to reduce donor site morbidity and skin durability after skin graft. Last a decade, many skin substitutes have been frequently used for this purpose. Recently as one of dermal templates, Matriderm(R) (Dr. Suwelack Skin and Health Care AG, Billerbeck, Germany), a elastin-collagen complex, has been introduced. We present clinical experiences using Matriderm(R) for reconstruction of skin defects after burn. METHODS: We have experienced 8 cases of reconstruction of the full thickness skin defects of the acute burn wounds or burn scar contractures using Matriderm(R) in 6 patients. After insetting this dermal templates on the skin defects sites, simultaneously 8~12/1000 inch split-thickness skin grafts were over-grafted immediately. The rate of graft engraftment, appearance, rate of contractures, durability and sensibility of grafted area have been observed. RESULTS: The skin defects on face, hand, extremities were reconstructed and it's size were varied from 2x2 cm2 up to 8x2 cm2. The follow-ups varied between 4 months and 1.4 years. The rate of engraftment of Matriderm(R) site was mean 97.2% and it was relatively successful. The rates of contractures of graft site were ranged from 8 to 59.4%. In case of postburn scar contractures of lower lid, severe contractures was noted. After long follow ups, there were reduced sensation, no sweating on grafted area of Matriderm(R) sites. At post operative 6 weeks, on microscopic examination of H/E stain, thick fibrosis, fragmentation of foreign materials, and on Masson's trichrome stain, dermal sclerosis were shown, and no skin appendage structures was noted. After long follow ups, the appearance, pliability and durability of the grafted area showed relatively good. But sensory return was incomplete. By using relatively thin STSG, the morbidity of donor site could be reduced. CONCLUSION: In the cases of reconstruction of postburn skin defects due to burn and after release of burn scar contractures, we have used a dermal templates, Matriderm(R), and simultaneously relatively thin STSG have been done. After follow ups, Matriderm(R) site showed in good results in terms of the engraftment, pliability and durability. Further studies for clinical use should be imperative.