Reconstruction of Full-Thickness Defects With Bovine-Derived Collagen/Elastin Matrix: A Series of Challenging Cases and the First Reported Post-Burn Facial Reconstruction
July 2012 | Volume 11 | Issue 7 | Original Article | 866 | Copyright © 2012
Reconstruction of full-thickness defects may benefit from integration of dermal substitutes, which serve as a foundation for split-thickness
skin grafts, thus enhancing short and long-term results. We present a series of 7 patients who were treated between 2010 and 2012 for
complicated full-thickness defects by the second-generation collagen/elastin matrix Matriderm® covered by a split-thickness skin graft.
The defects resulted from malignancy resection, trauma, and post-burn scar reconstruction. Overall graft take was excellent and no complications
were noted regarding the dermal substitute. Graft quality was close to normal skin in terms of elasticity, pliability, texture, and
color. Good contour and cushioning of defects in weight bearing areas was also achieved. Matriderm was found to be a useful adjunct to
full-thickness defect reconstruction, especially in difficult areas where the desired result is a scar of the highest quality possible.
J Drugs Dermatol. 2012;11(7):866-868.
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Full-thickness defects may result from extensive extirpation of malignant and nonmalignant lesions, various trauma and burn injuries and excision of hypertrophic or keloid scars in the course of scar revision surgery. Reconstruction of such defects constitute functional and structural surgical challenges, particularly if they include exposed bones or tendons, are located on weight-bearing areas or overlaying joints, or involve delicate, aesthetically significant areas such as the face. Regardless of the etiology, the reconstructive goal is aimed at achieving full coverage of the defect while regaining maximal resemblance to normal skin in appearance, texture, sensation, contour, and function. A split-thickness-skingraft (STSG) alone is sufficient in many cases yet its lack of dermal framework contributes to its aesthetic and functional drawbacks, mainly unsightly scars and contractures. Hence, dermal substitutes were developed and have been in use since 1970 to enhance the skin-like characteristics of the graft and to improve overall function.1 Matriderm® (Dr. Suwelack Skin and Health Care AG, Billerbeck, Germany) is an acellular dermal matrix from bovine nuchal ligament and dermis (GfN-Herstellung von Naturextrakten GmbH, Michelbach, Germany), which contains collagen (types I, II, and V) and alpha-elastin-hydrolysate.2-5 We present a series of 7 complicated full-thickness wounds reconstructed by Matriderm together with a STSG, evaluating its versatility and potential for recovering near-normal skin function and appearance in grafted areas.
From 2010 and 2012, seven patients (3 males, 4 females) with a mean age of 49.7 years (range 16 to 89 years) were treated for fullthickness skin defects of varying locations, extent, and etiologies (Table 1). Patient I presented with a full-thickness, bone-exposing wound over his malleolus as a result of a motorcycle accident. Patients II and III were admitted with defects on the weight-bearing areas of their feet following wide excision of squamous cell carcinoma (SCC), and patient IV was left with a full-thickness defect complicated by exposed bone over her shin after resection of a keratinizing SCC. Patient VI suffered a combined deep second and third degree scald burn to her right breast. Patient VI had severe, 2 cm thick facial keloid scars from a scald burn several years before and came in seeking aesthetic and functional improvement. Patient VII was treated for acute third degree sulfuric acid burns to his entire right hemiface (Figure 1). All procedures were carried out under general anesthesia. All patients had undergone staged surgical reconstructions, excluding patient VI who underwent tangential excision of the scars down to the SMAS and immediate grafting in a single stage.