A Histological and Clinical Study of MatriDerm® Use in Burn Reconstruction.

Dermal substitutes are well established in the reconstructive ladder. MatriDerm® (Dr. Otto Suwelack Skin & Health Care AG, Billerbeck, Germany) is a single layer dermal substitute composed of a bovine collagen (type I, III and V) and elastin hydrolysate, that allows for immediate split thickness skin grafting. The aim of this study was to histologically characterize the integration of MatriDerm® when used during burns surgery reconstruction. Eight subjects with nine burn scars and one acute burn wound underwent reconstruction with MatriDerm® and an immediate split thickness skin graft. MatriDerm® integration and skin graft take were assessed with serial biopsies performed at week 1, 2, 3, 4 and months 2, 3, 6, 9 and 12. Biopsies were assessed with standard special stains and immunohistochemistry, and representative slides were imaged with Transmission Electron Microscope. Patient satisfaction and clinical scar outcome was assessed with the Vancouver Scar Scale (VSS) and a patient questionnaire. Histological analysis showed similar stages of wound healing as shown in other dermal templates but on a different timescale. There is early evidence of vascularization and an inflammatory infiltrate in the first two weeks. MatriDerm® is resorbed earlier than other dermal substitutes, with evidence of resorption at week 3, to be completely replaced by a neodermis at 2 months. The use of MatriDerm® in reconstruction with immediate skin grafting is supported histologically with early evidence of vascularization to support an epidermal autograft. Future histological studies may help further characterize the ideal dermal substitute.