Use of a synthetic dermal matrix for reconstruction of 55 patients with non-graftable wounds and management of complications.

The aim of this study was to investigate the role of a completely synthetic dermal matrix (Biodegradable Temporising Matrix) for staged reconstruction of complex wounds. The authors defined complex wounds as wounds not amenable to reconstruction with skin grafting alone due to an inherent avascularity such as the presence of bare bone, tendinous or neural structures. A retrospective review of a prospectively maintained database of complex wounds as defined above was carried out. 55 patients were identified who underwent staged Biodegradable Temporising Matrix and autologous skin graft reconstruction for complex wounds affecting a wide variety of patient demographics, treatment indications and body sites. Wound aetiology included burn injury and non-burn related trauma such as degloving injury or infective complications. Caveats relating to successful application of staged dermal matrix reconstruction, techniques, tips, prevention and management of complications are outlined. This large consecutive case series, demonstrates the integral role dermal substitutes play in providing biological wound cover for avascular wound beds which may otherwise require complex distant flap or free tissue transfer for reconstruction. Staged synthetic dermal matrix reconstruction has proven robustness in the face of unfavourable wounds compared with non-synthetic dermal matrices, physiologically covering avascular structures, allowing for early graft take, expediting rehabilitation and mobilisation with good scar cosmesis and limited contracture formation.