The Capacity of 2 mm Matriderm(R) as a Dermal Substitute in Single Stage Skin Resurfacing

PURPOSE: Matriderm(R) is a highly porous dermal substitute consisting of a collagen matrix (collagen type I, III, and V) cross-linked to an elastin hydrolysate. The 1 mm thickness Matriderm(R) is used in a one-stage procedure. On the other hand, 2 mm thickness Matriderm(R) has been used in two-stage procedures in combination with split thickness skin grafts (STSG) for reconstruction as dermal substitute. To the best our knowledge, there is no case that reports the single stage procedure with 2 mm thickness Matriderm(R). There are many expected advantages if a two-stage surgery could be performed by one-stage procedure as long as the result is guaranteed. The purpose of this study is to present capacity of 2 mm thickness Matriderm(R) as a dermal substitute in single stage skin grafting by the successful results of six cases. METHODS: We performed this one-stage procedure in five patients instead of soft tissue reconstruction. Those patients were required soft tissue reconstruction after trauma injuries or radial forearm harvest as a donor site in the period between 2011 and 2012. Five Patients were treated with a combination of STSG and 2 mm thickness Matriderm(R) solely. Three out of five patients who were injured by trauma got transplanted splint thickness skin that were range from 4/1000~8/1000 inches (Table 1). Patients' data were analyzed retrospectively by chart review and patients interviews. Each patient's chart was reviewed for age, gender, type of injury, complications, final outcome and successful rates. RESULTS: The patient group consisted of 4 men and 1 woman between ages of 5 and 70. The clinical results of these five treated patients concerning skin-quality and coverage of exposed soft tissue were very good. Using 2 mm thickness Matriderm(R) the wound could gain more dermal substitute compare to 1 mm thickness Matriderm(R). CONCLUSION: Matriderm(R) is a single-use three-dimensional matrix composed of native, structurally intact collagen fibrils and elastin for supporting dermal regeneration. In this study five patients with trauma injuries or radial forearm harvest as a donor site were treated with 2 mm thickness Matriderm(R) as a dermal substitute and STSG as a single-stage procedure to cover exposed structures. Compare to 1 mm Matriderm(R), 2 mm thickness Matriderm(R) provide more dermal collagen and enhance skin-elastisity. Achieving single stage STSG with 2 mm thickness Matriderm(R), patient's hospital days were reduced in half and infection chances were also decreased. In conclusion, single skin grafting with 2 mm thickness Matriderm(R) is feasible and it is time-effient and cost effective procedure.

Surgical Treatment of Polyotia

Polyotia is an extremely rare type of the auricular malformation that is characterized by a large accessory ear. A 3-year-old girl presented to us with bilateral auricular abnormalities and underwent two-stage corrective operation for polyotia. In this report, we present the surgical details and postoperative outcomes of polyotia correction in the patient. Relevant literature is reviewed.

The Use of Matriderm and Autologous Skin Graft in the Treatment of Full Thickness Skin Defects

BACKGROUND: For patients with full thickness skin defects, autologous Split-thickness skin grafts (STSG) are generally regarded as the mainstay of treatment. However, skin grafts have some limitations, including undesirable outcomes resulting from scars, poor elasticity, and limitations in joint movement due to contractures. In this study, we present outcomes of Matriderm grafts used for various skin tissue defects whether it improves on these drawbacks. METHODS: From January 2010 to March 2012, a retrospective review of patients who had undergone autologous STSG with Matriderm was performed. We assessed graft survival to evaluate the effectiveness of Matriderm. We also evaluated skin quality using a Cutometer, Corneometer, Tewameter, or Mexameter, approximately 12 months after surgery. RESULTS: A total of 31 patients underwent STSG with Matriderm during the study period. The success rate of skin grafting was 96.7%. The elasticity value of the portion on which Matriderm was applied was 0.765 (range, 0.635-0.800), the value of the trans-epidermal water loss (TEWL) was 10.0 (range, 8.15-11.00) g/hr/m2, and the humidification value was 24.0 (range, 15.5-30.0). The levels of erythema and melanin were 352.0 arbitrary unit (AU) (range, 299.25-402.75 AU) and 211.0 AU (range, 158.25-297.00 AU), respectively. When comparing the values of elasticity and TEWL of the skin treated with Matriderm to the values of the surrounding skin, there was no statistically significant difference between the groups. CONCLUSIONS: The results of this study demonstrate that a dermal substitute (Matriderm) with STSG was adopted stably and with minimal complications. Furthermore, comparing Matriderm grafted skin to normal skin using Cutometer, Matriderm proved valuable in restoring skin elasticity and the skin barrier.

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.

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.