Materials and Methods
This retrospective cohort study included patients with acute complex wounds treated by the author at Rede D'Or São Luiz Hospital (São Paulo, Brazil) between January 2015 and December 2018. Treatment consisted of debridement of devitalized tissue, wound bed preparation, implantation of DRM either 1-mm or 2-mm thick, and STSG. Multiple wounds were included, with no restrictions related to etiology or topography. Exclusion criteria were chronic wounds (ie, more than 3 weeks' duration before the initiation of treatment), injuries sequelae treatments, and other types of salvage procedures to manage complications.
Negative pressure wound therapy (NPWT) was used in all cases, with dressing changes performed every 4 to 7 days. V.A.C. Therapy System (3M) was used in continuous mode at a pressure level of −125 mm Hg. A silver-coated foam dressing was used during the initial phase of treatment. A nonadherent polyvinyl alcohol foam dressing was used after the implantation of the DRM and after STSG.
Implantation of the DRM was indicated when the wound was in good condition, that is, once granulation tissue was present and infection treatment was completed. Proper preparation, cleaning, and hemostasis of the wound are recommended before the matrix is applied. It is important to note that DRM is not a substitute for basic debridement, load relief, and local vascularization optimization procedures.
The product used in this case series (MatriDerm; MedSkin Solutions Dr. Suwelack) can be used immediately after removal from the package. No special preparation is required; the matrix is cut to size before application. After the material is placed on the wound, the product is hydrated with saline solution until the product changes color, from white to translucent.
In cases in which it is possible to use 1-mm–thick DRM, STSG is performed simultaneously. The DRM and the skin grafts were fixed with stitches or staples to the margins and the wound site. Routine management for all cases included the complementary use of NPWT to aid fixation and integration of the DRM and skin grafts.
Split-thickness skin grafting should not be performed in the same procedure if a 2-mm–thick DRM is required. In cases in which a 2-mm–thick DRM is required, STSG can be performed 6 to 9 days after application of the matrix. The same steps are used for fixation and NPWT after this stage. In such cases as the current study, NPWT was used to accelerate and improve maturation and integration of the DRM.
The result at 12 months postoperatively was the primary outcome measure. This was assessed using the Vancouver Scar Scale (VSS), which has 4 subscales: pigmentation (0–3), pliability (0–4), vascularization (0–3), and scar height (0–4). In each subscale, normal presentation receives a score of zero. The highest possible score is 14. No other statistical analyses were conducted.
The author chose to include different wound etiologies and topographies. Analysis of functional results, such as angular extension or range of motion, is not included.
Wounds. 2022;34(6):154-158. © 2022 HMP Communications, LLC