INTRODUCTION
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.
METHODS
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.
