Soft Tissue Defects, Congenital Syndactyly & Skin Necrosis


Use of a collagen-elastin matrix for hard to treat soft tissue defects.

https://www.ncbi.nlm.nih.gov/pubmed/21449935
2011 Jun;8(3):291-6. doi: 10.1111/j.1742-481X.2011.00785.x. Epub 2011 Mar 30.

Wollina U1, Meseg A, Weber A.

Abstract

As deep soft tissue defects with exposed bone, cartilage or tendons are not suitable for wound closure with skin mesh grafts, other techniques are needed. We report on six patients, one female and five males, aged between 32 and 89 years, and deep soft tissue defects with exposed tendons, cartilage or bone. The aetiology of these defects was vascular (n = 3), tumour surgery (2), and post-traumatic (1). Wounds were treated with a collagen-elastin matrix applied above the exposed structures. In five patients, the procedure was combined with mesh graft transplantation in the same setting. Follow-up varied between 12 and 40 weeks. Wound healing was uncomplicated in all transplanted patients until first dressing change after 7 days. All but one transplant showed a 100% take rate and the transplant was stable within 10-14 days. A complete wound closure was also achieved without transplantation, but this took 8 weeks. No adverse effects were noted. There was no skin contracture of the skin grafts. Collagen-elastin matrix with split-thickness skin grafts is a useful tool in deep soft tissue. The time to heal can be reduced.


Management of defects on lower extremities with the use of matriderm and skin graft.

https://www.ncbi.nlm.nih.gov/pubmed/25075354

2014 Jul;41(4):337-43. doi: 10.5999/aps.2014.41.4.337. Epub 2014 Jul 15.

Choi JY1, Kim SH1, Oh GJ1, Roh SG1, Lee NH1, Yang KM1.

Abstract

BACKGROUND:

The reconstruction of large skin and soft tissue defects on the lower extremities is challenging. The skin graft is a simple and frequently used method for covering a skin defect. However, poor skin quality and architecture are well-known problems that lead to scar contracture. The collagen-elastin matrix, Matriderm, has been used to improve the quality of skin grafts; however, no statistical and objective review of the results has been reported.

METHODS:

Thirty-four patients (23 male and 11 female) who previously received a skin graft and simultaneous application of Matriderm between January 2010 and June 2012 were included in this study. The quality of the skin graft was evaluated using Cutometer, occasionally accompanied by pathologic findings.

RESULTS:

All 34 patients showed good skin quality compared to a traditional skin graft and were satisfied with their results. The statistical data for the measurement of the mechanical properties of the skin were similar to those for normal skin. In addition, there was no change in the engraftment rate.

CONCLUSIONS:

The biggest problem of a traditional skin graft is scar contracture. However, the dermal matrix presents an improvement in skin quality with elastin and collagen. Therefore, a skin graft along with a simultaneous application of Matriderm is safe and effective and leads to a significantly better outcome from the perspective of skin elasticity.


Matriderm for Management of Scalp Necrosis Following Surgical Treatment of Giant Parietal Encephalocele.

https://www.ncbi.nlm.nih.gov/pubmed/29102755

2018 Feb;110:30-34. doi: 10.1016/j.wneu.2017.10.130. Epub 2017 Nov 2.

Vilela MD1, Pedrosa HAS2, Sampaio FD3, Carneiro JL3.

Abstract

BACKGROUND:

Management of encephaloceles is challenging when massive brain herniation is present. In such instances, an expansile cranioplasty may be attempted so as to preserve some herniated brain tissue. Complications such as wound dehiscence, cerebrospinal fluid leak, and scalp necrosis are postoperative concerns. The treatment of scalp necrosis with dural and brain exposure is certainly a challenge due to the complexity of flap techniques in such a young age. Herein we describe the use of a novel technique for the management of a scalp necrosis and dehiscence in an infant.

CASE DESCRIPTION:

A patient with a giant parietal encephalocele and massive brain herniation underwent an expansile cranioplasty. A large scalp necrosis ensued as a complication and later progressed to a suture dehiscence despite a new surgical intervention, with resultant brain exposure. A scalp reconstruction was subsequently performed using an artificial dermal substitute, laid directly onto the brain, followed by a split-thickness skin graft. We observed a rapid engraftment, without any further complications, with an acceptable cosmetic result in the long-term follow-up.

CONCLUSION:

A simple technique, such as the use of an artificial dermal matrix with simultaneous split-thickness skin graft, may be an effective treatment for the repair of scalp defects, even when coverage of exposed brain tissue is necessary, when no other techniques are found to be suitable.


MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery.

https://www.ncbi.nlm.nih.gov/pubmed/28843466

2017 Oct;14(10):1277-1284. doi: 10.1016/j.jsxm.2017.08.003. Epub 2017 Aug 23.

Watfa W1, di Summa PG2, Meuli J2, Raffoul W2, Bauquis O2.

Abstract

BACKGROUND:

Phalloplasty with the radial forearm free flap is associated with a large donor site defect.

AIM:

To compare two methods of donor site closure for functional and cosmetic long-term results: full-thickness skin grafting vs split-thickness skin grafting with MatriDerm.

METHODS:

Thirty-seven transgender patients had a neophallus created from a radial forearm free flap, and all were operated on by the same senior surgeon. Eight patients had their donor site defect closed by total skin grafting and 29 patients, operated on after 2009, received a split-thickness skin graft with MatriDerm closure. All 37 patients were evaluated by questionnaire and by careful clinical examination. Pressure perception was assessed with the Semmes-Weinstein monofilament test. Sensory recovery, skin quality, and cosmetic result also were compared. The contralateral arm was used as the control.

OUTCOMES:

Pressure perception values showed better sensory return in the MatriDerm group. Split-thickness skin grafting with MatriDerm achieved superior results in skin sensibility, superficial radial nerve recovery, and cosmetic aspect.

RESULTS:

Our findings support the hypothesis that MatriDerm can be used to preserve sensory function and decrease morbidity of the donor site.

CLINICAL IMPLICATIONS:

The use of a dermal substitute decreases the morbidity of the forearm free flap donor site.

STRENGTHS AND LIMITATIONS:

The strength of this study is its retrospective nature conducted of a prospectively maintained database of 37 consecutive radial forearm free flaps with superimposable dimensions and location performed by the same surgeon, thus limiting biases. A limitation is its small sample (particularly for the control group).

CONCLUSION:

Our experience showed that the combination of a split-thickness skin graft with MatriDerm substantially decreases postoperative complications at the donor site defect on the forearm of transgender patients. Watfa W, di Summa PG, Meuli J, et al. MatriDerm Decreases Donor Site Morbidity After Radial Forearm Free Flap Harvest in Transgender Surgery. J Sex Med 2017;14:1277-1284.


Use of a collagen-elastin matrix for hard to treat soft tissue defects.

https://www.ncbi.nlm.nih.gov/pubmed/21449935
2011 Jun;8(3):291-6. doi: 10.1111/j.1742-481X.2011.00785.x. Epub 2011 Mar 30.

Wollina U1, Meseg A, Weber A.

Abstract

As deep soft tissue defects with exposed bone, cartilage or tendons are not suitable for wound closure with skin mesh grafts, other techniques are needed. We report on six patients, one female and five males, aged between 32 and 89 years, and deep soft tissue defects with exposed tendons, cartilage or bone. The aetiology of these defects was vascular (n = 3), tumour surgery (2), and post-traumatic (1). Wounds were treated with a collagen-elastin matrix applied above the exposed structures. In five patients, the procedure was combined with mesh graft transplantation in the same setting. Follow-up varied between 12 and 40 weeks. Wound healing was uncomplicated in all transplanted patients until first dressing change after 7 days. All but one transplant showed a 100% take rate and the transplant was stable within 10-14 days. A complete wound closure was also achieved without transplantation, but this took 8 weeks. No adverse effects were noted. There was no skin contracture of the skin grafts. Collagen-elastin matrix with split-thickness skin grafts is a useful tool in deep soft tissue. The time to heal can be reduced.


Surgical Therapy by Sandwich Transplantation using a Dermal Collagen-Elastin Matrix and Full Thickness Split Grafts and Gait Rehabilitation with Individualized Orthesis.

https://www.ncbi.nlm.nih.gov/pubmed/23378711

2012 Oct;5(4):277-80. doi: 10.4103/0974-2077.104917.

Wollina U1, Heinig B.

Abstract

Painful callosities of the feet (PCOF) are a rare complaint in children with severe impairment of mobility and quality of life. There is no medical treatment available. We investigated the usefulness of a recently developed combined transplant technique-the sandwich transplantation with dermal collagen-elastin template in this rare condition. A 14-year-old boy suffered from PCOF for several years without any improvement by topical therapy, dermabrasion, and oral retinoids. He was unable to walk normally and suffered from severe pain. We performed a complete deep excision of the hyperkeratotic plantar tissue in general anaesthesia in combination with sandwich transplantation in the same setting. Dry sheets of collagen-elastin matrix (1 mm thickness) were placed on the soft tissue defects and covered by full-thickness mesh graft transplants from the upper leg. An individualized orthosis was produced for gait rehabilitation. Two weeks after surgery the gait-related pain was reduced remarkably. Using the orthosis, the boy was able to walk pain-free even on staircase. Surgery of PCOF with sandwich transplantation and gait rehabilitation appears to be a promising strategy for this rare condition.


A novel approach to reconstruct a large full thickness abdominal wall defect: successful treatment with MatriDerm® and STSG

https://www.ncbi.nlm.nih.gov/pubmed/25041311

DOI:10.12968/jowc.2014.23.7.355

2014 Jul;23(7):355-7. doi: 10.12968/jowc.2014.23.7.355.

Tong E1, Martin F, Shelley O.

Abstract

Reconstruction of large abdominal wall defects is a challenging procedure, often contraindicated in critically ill patients, with high incidences of complications. We present a case of a patient with a large abdominal wall defect who had reconstruction with MatriDerm® (an engineered dermal template) and split thickness skin grafting (SSG) as an alternative to reconstruction with myo- or fascio-cutaneous flaps. Successful wound closure was achieved with a single technique, while providing a robust reconstruction and an interface between skin and underlying viscera, should further surgery be necessary.


Surgical Treatment of Polyotia.

https://e-acfs.org/journal/view.php?doi=10.7181/acfs.2015.16.2.84

2015 Aug;16(2):84-87. doi: 10.7181/acfs.2015.16.2.84. Epub 2015 Aug 11.

Rha EY1, Kim DH2, Byeon JH2.

Abstract

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 have reported a successful correction of polyotia using extraneous tissue and dermal substitute. Relevant literature is reviewed.


Skin necrosis of scrotum due to endovascular embolisation: a case report.

https://www.ncbi.nlm.nih.gov/pubmed/21883935

2012 Feb;9(1):70-5. doi: 10.1111/j.1742-481X.2011.00847.x. Epub 2011 Aug 31.

Cervelli V1, Brinci L, Palla L, Spallone D, Izzo V, Curcio CB, Lucarini L, De Angelis B.

Abstract

The aim of our case report was to analyse the results obtained with the Matriderm® system and autologous skin grafting for the surgical treatment of skin necrosis of scrotum as a result of endovascular embolisation. We recruited one patient with scrotum skin necrosis as a result of endovascular embolisation admitted at the department of Plastic and Reconstructive Surgery, University of Rome ‘Tor Vergata’. The patient underwent Matriderm® system and autologous skin grafting for skin necrosis treatment. After a single treatment, reduction of the skin necrosis was obtained, after 30 days from the surgical treatment. Patient experienced a reduction in pain and a complete restoration of the loss in volume and quality of skin was noticed. Matriderm® system and autologous skin grafting is a simple, safe and feasible technique. When comparing this treatment with others, Matriderm® is a simpler, more economic and less time-consuming method, and does not require sophisticated laboratory facilities.


Matriderm® in depth-adjusted reconstruction of necrotising fasciitis defects.

https://www.ncbi.nlm.nih.gov/pubmed/20392567

2010 Nov;36(7):1107-11. doi: 10.1016/j.burns.2009.12.002. Epub 2010 Apr 14.

Ryssel H1, Germann G, Czermak C, Kloeters O, Gazyakan E, Riedel K.

Abstract

Necrotising fasciitis (NF) and Fournier’s gangrene are still a source of high morbidity and mortality and a significant health-care resource consumption. These difficult cases are increasingly being referred to burn centres for specialised wound and critical care issues. Besides the total body surface area (TBSA) affected, location, co-morbidities, age and an immediate surgical treatment are important prognostic factors. The treatment of these patients is challenging and best performed by prompt diagnosis, immediate radical surgical debridement and aggressive critical care management. Referral to a major burn centre may help provide optimal surgical intervention, wound care and critical care management.As soon as the patient is stabilised, reconstruction of the injured areas becomes the main focus. As often seen, complete loss of dermal structures needs a depth adjusted–‘multilayer’–reconstruction especially in critical areas. In modern reconstructive surgery, concepts of layer-specific reconstruction, including dermal substitution have to be considered. In this article, we present our recent experiences of five patients with NF who underwent dermal reconstruction with Matriderm® not only for better skin quality but also in some cases as an alternative to flap surgery when joint capsules or tendons were exposed.


Interest of dermal substitute (Matriderm ©) to cover long fingers after congenital syndactyly: About 20 commissures.

https://www.ncbi.nlm.nih.gov/pubmed/25447213  [Article in French]

2015 Aug;60(4):284-90. doi: 10.1016/j.anplas.2014.09.010.

Truffandier MV1, Perrot P2, Duteille F3.

Abstract

INTRODUCTION:

Surgical treatment of congenital syndactylies is based on the creation of a new commissure – with a commissural flap – and on the management of fingers lateral faces – with mirror zigzag incisions. Lateral skin defects are covered by full-thickness skin graft. Since their discover 30 years ago, dermal substitutes applications have been enlarged. We have wandered if these technique could be interesting for the treatment of these lateral skin defects.

MATERIALS AND METHOD:

We have launched a monocentric and retrospective study with only one surgeon. The assessor and the operator were different. Included patients have a simple or complex congenital syndactyly, complete or not, associated with a syndrome or not. Children with a first web space syndactyly were excluded. Surgical treatment was performed with a dorsal commissural flap, with mirror incisions and with a lateral skin defects coverage by dermal substitute (Matriderm(©)) and split-thickness skin graft taken from the scalp. The initial assessment criterion was the quality of the scare measured by the OSAS score. Web creep (Whitney’s scale) and time of surgery were two minor criteria.

RESULTS:

Twenty commissures (11 children) have been included between 2008 and 2013. Fourteen complex syndactylies were noted. The average aftercare was equal to 2.7 years (0.5-5.5 years). Interventions were performed at the age of 1.8 years (0.5-4 years). Surgical time was equal to 44.6 min (22-95 min). Patients OSAS score was 11.9 (6-18). It was 12.2 (60-20) for complex forms and 11.9 (10-16) for simple forms. Graft weren’t hairy. There was no complication on the donor site. Whitney’s score was 1.2 (0-3) and three web spaces were reoperated.

CONCLUSION:

We think that the use of dermal substitute Matriderm(©) is a new and serious alternative to treat congenital syndactylies. Results have to be confirmed by a new study which would compare this material to full-thickness skin graft, gold standard technique for these skin defects.


Matriderm‘ dermal substitute with split-thickness skin graft compared with full-thickness skin graft for the coverage of skin defects after surgical treatment of congenital syndactyly: results in 40 commissures.

https://www.ncbi.nlm.nih.gov/pubmed/26141023

2016 Mar;41(3):350-1. doi: 10.1177/1753193415594101. Epub 2015 Jul 3.

Duteille F1, Truffandier MV2, Perrot P3.

Abstract

A retrospective study of treatment of congenital syndactyly in our institution between 2007 and 2011 identified 21 patients with 40 commissures, operated by the same senior surgeon.

Surgical times using Matriderm were, on average, 10.5 minutes shorter than procedures using full- thickness graft, a reduction of 19%.

We have observed that dermal substitute might have other advantages over full-thickness skin graft. First, the reduction of surgical time by 10.5 minutes is significant; this is important because surgery is performed on very young children in whom tourni- quet time must be limited and hypothermia must be prevented. Shortening the procedure also minimizes the risk of sepsis. This surgical rapidity is explained by the skin donor site, which requires no haemosta- sis or closure. The shortening is cumulative when treating multiple digits. The other advantage of dermal substitute is the absence of scarring at the donor site; the skin is taken from the scalp and the difference of pigmentation is hidden by hair growth. Furthermore, the skin capacity is nearly unlimited which is particularly important in cases of multiple and bilateral syndactylies. Finally, the risk of hair growth on the graft with a full-thickness graft collected from the groin is avoided with the use of Matriderm.


Matriderm vs Integra Dermal Regeneration Template Single Layer as a Dermal Substitute for Synchronous Autologous Skin Grafting in Necrotising Fasciitis – a Case Study

https://applispublishers.com/matriderm-vs-integradermal-regeneration-template-single-layer-as-a-dermal-substitute-for-synchronous