Dermal Regeneration Matrix in the Treatment of Acute Complex Wounds

Daniel Francisco Mello, PhD

Disclosures

Wounds. 2022;34(6):154-158. 

In This Article

Discussion

The DRM used in this report has been available in Europe since 2004. It is of bovine origin, containing collagen type I, III, and V derived from the dermis, without cross-linking, associated with alpha elastin hydrolyzed, in a proportion of 3%, derived from the nuchal ligament. The product is macroporous, with pore diameters of 20 μm to 100 μm.[1,5,8,10]

The DRM can serve as a structure for dermal regeneration and for modulating scar tissue formation; it also has hemostatic properties.[3] The collagen in the product degrades and is reabsorbed within 6 weeks; it is replaced by the autogenous fibroblast that invaded the neodermis.[6,9,11]

According to some authors, elastin is the reason for the improved performance of the studied DRM compared with other matrices.[9,12,13] The reduced granulation tissue formation that occurs at the earliest stage of healing results in the formation of collagen with a more random organization.[1,14,15] In humans, there is no proper regeneration or repair of elastin fibers destroyed in a wound.[15] Elastin regulates collagen contraction, interrupts differentiation from fibroblasts to myofibroblasts, and reduces scar tissue formation.[16]

For several years, the 1-mm–thick DRM evaluated in the current case series was the only product available for use in a 1-step procedure with STSG.[6,14,16] In 2010, a matrix with similar characteristics (Integra Dermal Regeneration Template Single Layer [Integra LifeSciences]) was released.[15] Other currently available DRMs require 2-stage procedures, whether a single-layer product (eg, the studied DRM of 2 mm thickness), a double-layered product (eg, Integra [Integra LifeSciences], Nevelia [Symatese Aesthetics], Pelnac [Gunze]), or a trilayered product (Oasis Ultra [Smith + Nephew]).

In the current case series, the use of a 1-mm–thick DRM immediately followed by STSG did not result in increased complication rates. Favorable results were observed in the 6 patients treated thus in the current series and have been reported elsewhere.[16,18–20]

Results observed in patients treated with the DRM used herein include increased elasticity and pliability, reduction in scar contracture, and optimization of aesthetic and functional results.[1,4,11,21] In the current case series, stable results were observed at a minimum of 18 months postoperatively, and subjective analysis indicated improvement over time, with no wound healing complications.

Previously published studies have reported better results with DRM compared with conventional STSG as measured by VSS scores and joint mobility measures.[5,15,17,18,22] van Zuijlen and colleagues[7,11] described gains of approximately 30% in extension and elasticity, and of 50% in flexibility using the DRM. In other studies in which factors such as humidity and water loss were analyzed, results also were better with the use of DRM.[2,19]

Dermal regeneration matrices can be used to cover tendons, bones, and joint capsules, which avoids the need for more elaborate reconstruction, such as microsurgical flaps.[12,14,17,20] They can also be indicated as a rescue treatment in patients in whom other methods have failed. Use of the product in patients with injuries to the dorsum of the hand, as observed in 3 cases in the current series, anticipated physiotherapeutic rehabilitation process, also avoiding tendon or joint retractions.

Dermal regeneration matrices have low associated morbidity rates and a relatively simple learning curve.[11,21] Another advantage that should be considered is the reduced morbidity for the donor areas, because thinner skin grafts can be used.[5,14,19]

Negative pressure wound therapy increases matrix integration rates, shortens time to skin grafting, and reduces associated complications.[3,5,14] The author thinks routine use of NPWT for all patients in this case series was a significant factor in the results achieved and in the absence of complications, even more considering the profile of wounds treated, including high exudative and large wounds in difficult areas.

Costs are a limiting factor in the use of DRM in the management of acute complex wounds. In the initial phases of treatment, costs are higher than other options because of the cost of the product; however, final overall costs are decreased because of shorter wound resolution time, in addition to lower complication and morbidity rates.[4,15,22] Gains in functional improvement in such critical realms, like reliability and movement (eg, joint, dorsum of the hand), compensate for the financial costs associated with the product.[3–5,22]

Currently, no tissue-engineered skin substitute meets all the requirements of an ideal substitute, nor can it be used to achieve healing outcomes that are equal or superior to that achieved with autologous tissues.[9,10,21] Health professionals should consider different types of products based on the particular treatment goals[4,18] To date, no one particular type of DRM has been shown to be superior to any other.[5,7,9]

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