Six Year's Experience Application of Dermal Matrix for Vascular Wounds

Abstract

The purpose of this cross-sectional study is to evaluate the effectiveness of a dermal-epidermal matrix substitute (Integra Dermal Regeneration Template [IDRT]) for vascular wounds. Our primary end point was healing rate and recurrence rate. The secondary end point was comparing healing rate to bone expositions rate, hyperbaric oxygen therapy (HOT) and efficiency. We retrospectively reviewed all medical records of patients treated by IDRT from November 2016 to July 2021 by our team, to evaluate the effects of Integra in wound healing. The inclusion criteria was use of IDRT. We evaluated the ulcer and patient profile, use of hyperbaric therapy, negative-pressure therapy, healing and recurrence. A total of 40 patients were included; the median age was 65.5 years, 21 patients were female (52.5%) and 19 male (47.5%). The etiology of the wound was arterial in 10, mixed in 2, mycroangiopatic/hypertensive in 4, infectious in 4, traumatic in 13, and venous in 7. The global healing rate was 77.5%. Three (7.5%) patients have recently been submitted to the surgical procedure with use of the IDRT and still in follow-up. Thirty-seven (92.5%) used negative-pressure therapy during the treatment, 28 (75.6%) of them had their wounds healed and 9 (24.32%) did not. Eleven ulcers had bone exposure and sixteen had tendon exposure with healing rate of 90.9% and 81,35% respectively. Comorbidities were present in 34 (87,5%), in the most of cases hypertension in 26 (65%), diabetes in 24 (60%), and dyslipidemia in 18 (45%). Twelve (30%) of them needed revascularization before the IDRT and 14 (35%) patients realized HOT after. The HOT group had a healing hate of 92.85%, and no recurrence, in contrast to no-HOP that had respectively 69.23%, and 3.84% (P = .088). The arterial wounds had healing rate of 90% without recurrence and venous wound 71.4% and no recurrence. We had just one recurrence, in the mixed group (recurrence rate 50%). All patients with venous ulcer had yours varicose veins and/or obstructed veins treated and those with peripheral arterial disease were submitted to revascularization. In our experience, the use of IDRT is an important and helpful option in wound care. In addition, HOT may be an useful option in a limb salvage and wound healing program. We noticed a tendency of better healing in those patients in despite the absence statistical significance. The only patient who had recurrence of the ulcer did not follow the clinical treatment prescribed. We observed that the application of negative-pressure therapy could potentially increase the integration of dermal matrix and, could be a first-line treatment option for wounds with bone or tendon exposure.