Dermal Substitute Research Articles

Utilization of a Dermal Substitute (Hyalomatrix) in Pediatric Upper Extremity Procedures

Introduction Hyalomatrix is a skin graft substitute that may be able to be utilized as an alternative to partial or full thickness skin grafts in a variety of procedures involving the pediatric upper extremity. Composed of an esterified Hyaluronic Acid layer and a silicone layer, Hyalomatrix provides a matrix for dermal induction while protecting the wound from the external environment. The use of this skin graft substitute can potentially decrease the overall …

Utilization of a Dermal Substitute (Hyalomatrix) in Pediatric Upper Extremity Procedures

Utilization of a Dermal Substitute (Hyalomatrix) in Pediatric Upper Extremity Procedures

The Use of Dermal Substitute in Deep Burns of Functional/Mobile Anatomic Areas at Acute Phase After Early Excision and Subsequent Skin Autografting: Dermal Substitute Prevents Functional Limitations.

We aimed to evaluate the results of dermal substitute implantation after early excision in the acute phase of major burn cases within the scope of efforts to reduce contractions and scar formation in functional anatomic areas (face, neck, axilla, elbow, popliteal). Twelve patients with major burn who were treated in the burn center between September 2017 and September 2018 were included in the study. In these patients, Nevelia® dermal substitute was implanted into 24 functional areas with deep partial or full-thickness burns after surgical debridement of the wound. Autologous split-thickness skin graft was applied to these areas after 14 to 21 days. The patients were followed for 4 to 14 months (mean 6 months). Postoperative scar formation was assessed by the Vancouver Scar Scale at the end of the follow-up period. A simple qualitative staging system was used for aesthetic and functional evaluation. The time from burn injury to dermal substitute implantation was 3 to 21 days. Skin graft take was complete in 22 of 24 regions and partial in one of them, while graft loss developed in one region. In the implantation sites, the Vancouver Scar Scale ranged from 1 to 7. The aesthetic and functional evaluation showed excellent/good results in 21 of 24 anatomic regions, moderate results in 2 regions, and poor results in 1 region. The use of dermal substitute in deep burns of functional/mobile anatomic areas at the acute phase after early excision and subsequent skin autografting has opened a new alternative area in the burn surgery arena to prevent contractures and functional limitations.

Outcomes of Pediatric Syndactyly Repair Using Synthetic Dermal Substitute

Full-thickness skin grafts are classically used for areas of skin deficit in syndactyly reconstruction surgery. However, skin grafting requires additional time under anesthesia and includes donor site morbidity. Synthetic dermal substitute has produced favorable web creep and scar appearance outcomes in syndactyly reconstruction. We sought to validate these results using objective outcome measures. All patients who had undergone syndactyly reconstruction with synthetic dermal substitute with 1-year follow-up were identified. We included 23 webs in 16 patients; 2 were lost to follow-up. Median age at surgery was 27 months; 7 patients were female. Five webs were revision surgeries. Two patients had a diagnosis of amniotic constriction band, and 3 had symbrachydactyly. All webs were assessed from blinded clinical photos. Outcome measures included web creep assessment (range, 0-5) and Vancouver Scar Scale. Of 21 webs, 2 had minimal creep and 16 had none; 3 had clinically relevant creep (grade 2). Vancouver Scar Scale scores for all webs averaged 1.19 (0 is normal). There was normal vascularity in 20 webs, pigmentation was normal in 17 webs, skin pliability was normal in 13 webs, and scar height was flat in 15 webs. On the visual analog scale assessment, surgeons rated the appearance of the 21 webs as an average of 8.8 (range, 5-10). There were no postoperative complications. Synthetic dermal substitute is an effective, efficient, and visually satisfactory option for coverage of skin deficits in syndactyly reconstruction. The current heterogeneous sample revealed that this approach can provide satisfactory outcomes for patients, families, and surgeons. Although no surgical complications were noted, the rate of integration and healing has yet to be determined. Therapeutic IV.

Reconstruction of Nasal Defects With Dermal Skin Substitutes-A Retrospective Study of 36 Defects.

It is uncertain whether dermal regeneration templates (DRTs) are helpful to reconstruct nasal defects. The aim of this study was to assess whether the aesthetic subunits determine the outcome. In this unicentric, retrospective study, the surgical procedures and outcomes of patients who received DRTs to reconstruct nasal defects were assessed and compared with the involved aesthetic subunits. DRTs were used for reconstruction of 36 nasal defects in 35 patients with involvement of 76 aesthetic subunits: nasal sidewall (n = 21), nasal ala (n = 13), nasal tip/columella (n = 12, n = 1, respectively), nasal dorsum (n = 12), and extranasal aesthetic areas (n = 17). Fifty-eight nasal and 8 extranasal aesthetic subunits were reconstructed with DRTs, 10 subunits with a flap. Twenty-nine of 36 defects healed without any complications (80.5%). All reconstructed nasal tips/columella and the nasal dorsa healed without any complications. Region-specific complications were retraction of the ala rim (4/12; 33.3% of the patients with involvement of the nasal ala) and the formation of a fistula in the nasal sidewall (1/21; 4.8%). Region-specific complications of extranasal subunits were the development of an ectropium (2/3; 66.7% of the patients with involvement of the lower lid). DRTs can be helpful to reconstruct nasal defects. However, if the defect involves the aesthetic subunits nasal ala or the infraorbital region, different techniques should be preferred.

Observational Study for the Long-Term Effects of a Dermal Substitute on Patients With Facial Burns.

Observational Study for the Long-Term Effects of a Dermal Substitute on Patients With Facial Burns.

Dermal Substitutes in the Setting of Flap Delay: A Reconstructive Technique to Enhance Flap Viability

Dermal Substitutes in the Setting of Flap Delay: A Reconstructive Technique to Enhance Flap Viability

Vasculogenic Chronic Ulcer: Tissue Regeneration with an Innovative Dermal Substitute.

The healing of venous and arterial ulcers is slow, and in some cases, they may not heal at all. This study aims to demonstrate the clinical advantage of Nevelia®, an innovative collagen dermal template substitute (DS) in venous and arterial chronic ulcers treatment. 35 patients affected by chronic vascular ulcers with a mean area of 35.1 ± 31.8 cm2 were treated with DS followed by autologous dermal epidermal graft (DEG). Follow-up was performed at 7-14-21 and 28 days after DS implant and 7-14-21 and 28 days after DEG. At 28 days after DEG, the mean values of Manchester Scar Scale was of 1.8 ± 0.7 for skin color, 1.6 ± 0.7 for skin contour, 1.7 ± 0.7 for distortion, and 1.7 ± 0.7 for skin texture, whereas skin was matte in 27 patients (77%) and shiny in the remaining eight cases (23%). Histological findings correlate with the clinical result showing a regenerated skin with reactive epidermal hyperplasia and dermal granulation tissue after two weeks (T1), and after three weeks (T2) a re-epithelialization and a formed new tissue architecture analogue to normal skin physiology. These data suggest that Nevelia® could be useful to treat chronic venous and arterial ulcers.

333 The First Twenty: The Use of Synthetic Dermal Substitute in Significant Burns; Outcomes and Lessons Learned

333 The First Twenty: The Use of Synthetic Dermal Substitute in Significant Burns; Outcomes and Lessons Learned

Evaluation of the Use of Single Stage Dermal Substitutes in Acute and Chronic Wounds of the Hand

Background: Skin substitutes were developed as an alternativeto skin grafts, especially for burn patients. Autologousskin grafting is a painful procedure, and often the extent ofdamaged skin is too large to be covered by autologous tissuegraft in existence of limited donor skin. Our aim of the studywas to evaluate the use of dermal substitutes in the treatmentof acute and chronic wounds of the hand and to establish anapplicable protocol of definitive wound management.Methods: The study included 85 adult patients havingacute and chronic wounds of the hand. They were dividedinto 2 groups Group (A): Fifty-five Patients treated withSingle-layer dermal substitutes and STSG applied to thewound bed in a one-stage procedure, group (B): Thirty Patientstreated with skin grafting alone. Scar Evaluation was doneby Pre-& post-operative photography. The Vancouver ScarScale, Histopathological examination at 45 days postoperatively,Range of motion and Patient satisfaction.Results: Statistical analysis showed significant differencesbetween the two groups.Conclusion: A true “skin substitute” would act like anautologous skin graft in adhering to the wound bed whileproviding the physiological and mechanical functions ofnormal skin. The use of dermal substitutes represents a promisingtreatment for acute burns and chronic wounds.

Our experience with dermal substitute Nevelia® in the treatment of severely burned patients.

This research aims to retrospectively evaluate the effectiveness and safety of dermal substitute (DS), Nevelia®, for the treatment of severely burned patients. Twenty severely burned patients were enrolled in this study between May 2017 and May 2018. After escharotomy of the wound, the treatment protocol was applied following a two-step procedure -DS implantation followed by split-thickness skin graft (STSG) application. Need for surgery, complications, hospitalisation duration and overall survival were analysed. Mean age was 40.1±4 (18-86) years old; female/male: 5/15. Mean burn surface area was 50.1%±2 (25-96). Two patients died under hospital treatment due to the severity of their burn trauma and comorbidities. For the rest of the cases, STSG was performed after Nevelia® at mean 21.2 days. No complications due to Nevelia® were detected. The patients were discharged with a mean total recovery of 55.2±4 days. This study showed that Nevelia® can be used safely and effectively in severely burned patients with low complication rates and short hospital stay.

Improved Dermal Regeneration Using a Combination of Dermal Substitutes and Dermal Fibroblast Optimization: A Hypothesis

In human adults, the repair of cutaneous wounds usually leads to scar formation rather than regeneration. Dermal substitutes have been used as a regenerative template for reducing scar formation and improving the extent of dermal regeneration. However, achievement of complete regeneration is still a long way off. Dermal substitutes are characterized by unusual regenerative activity, appearing to function by acting as temporary configurational guides for cell infiltration and synthesis of new stroma. Fibroblasts are important cells with many vital functions in wound-healing processes. They are heterogeneous with distinct characteristics according to their source location, such as subcutaneous tissue, superficial-layer dermis, and deep-layer dermis. Many studies have shown that superficial dermal fibroblasts possess the potential to form dermis-like tissue. Fibroblasts in deep-layer dermis and subcutaneous tissue may play a critical role in the formation of hypertrophic scars. Fibroblast phenotype affects the newly formed dermal architecture and influences the dermal regeneration effect induced by dermal substitutes. It is hypothesized that better regeneration of the dermis can be achieved using dermal substitutes along with dermal fibroblast optimization.

519 The Application of Negative Pressure Wound Therapy to Promote Integration of Facial Grafts and Dermal Substitutes

Negative pressure is an important modality in our burn center’s treatment algorithm of acute burns and reconstructive patients. Many studies have cited the potential benefits of NPWT but few look at the feasibility of application in locations such as the face and the care that is required to provide a successful outcome while maintaining important underlying structures. Here, we present our techniques for successful application and outcomes in the application of NPWT to the face. Patients requiring dermal substitute placement or autografting to the face were evaluated by the staff surgeon in the OR for potential placement of NPWT. When the burn surgeon determined the wound bed was deemed appropriate, the physical therapist was called to place the NPWT dressing with assistance from the OR staff and surgeons. Due to the often complex nature of intricate grafting, specialty products were used to assist with the placement and maintenance of a seal. In areas of intact skin, skin glues and/or hydrocolloids were used. When the graft was bordered with continued burn or open wounds, products such as ostomy paste and strip adhesives were used. Vital structures such as the eyes, ear canal, nares, and mouth require more attention. Silicone sheeting coupled with bolsters or other forms of compression were used to decrease the chance of residue from the ostomy products migrating into these areas. Low pressure settings were used (<75mmHg). The dressings were changed per the manufactures’ time frames. There were no areas of unplanned graft or dermal substitute loss as a direct result of the NPWT dressing being placed and no adverse events. In our burn center, we have utilized NPWT to the face since 2007 without sequelae. With appropriate wound bed preparation, practitioners proficient with placement of a NPWT dressing to the face and close monitoring, NPWT is a safe and beneficial dressing to assist with the vascularization, immobilization, and splinting of skin grafts and dermal substitutes placed on the face. Discussion of practices that work on difficult placement of NPWT will benefit less experienced practitioners.

35 First in Vitro and in Vivo Experiences with a New Synthetic Dermal Substitute with Dual Microporous Structure

35 First in Vitro and in Vivo Experiences with a New Synthetic Dermal Substitute with Dual Microporous Structure

Advances in the research of negative-pressure wound therapy inducing the vascularization of dermal substitute

In clinical practice, skin defects resulted from various acute and chronic diseases occur frequently. Dermal substitute (DS), known as dermal regenerative template, is used more and more widely, but the slow process of vascularization limits its clinical application. At present, there are many strategies developed to enhance the process of vascularization, such as modifying the structure of dermal scaffolds, prevascularization by seeding stem cells and/or endothelial cells. Recently, negative-pressure wound therapy (NPWT) emerged and rapidly became popular in promoting wound healing due to its intrinsic advantages. Furthermore, some researchers introduced this technique to accelerate the vascularization process of DS. This paper represents a comprehensive overview on the efficiency of NPWT in different combination models, and the related mechanism.

Effect of Cultured Dermal Substitute Composed of Collagen Sponge Seeded with Fibroblasts in Simultaneous Skin Graft Overlay

An artificial dermal substitute composed of a xenogenous collagen sponge has been widely used to create a dermal component in a full-thickness skin wound. However, one of the disadvantages in using the dermal substitute is that it requires a 2-stage surgical procedure for final wound closure. In order to close the wound much more rapidly, another type of dermal substitute which enables a simultaneous skin graft overlay is needed. In the present study, we investigated the effect of a collagen sponge seeded with isogenic fibroblasts on a simultaneously overlaid skin graft in a rat model. Normal dermal fibroblasts of SD rat were seeded and cultured on a collagen sponge composed of cross-linked porcine type I collagen. Full-thickness skin wounds were created on the dorsum of SD rats. The collagen sponges with or without fibroblasts were placed in the wounds, then covered simultaneously with split-thickness skin graft (STSG) . At 1 week and 4 weeks after grafting, overlaid STSG survival, TGF-β1 level, wound contraction, final re-epithelization and histology of the grafts were studied. The overlaid STSG survived moderately but the seeded fibroblasts did not enhance the STSG survival rate. Also, there were no significant differences in wound contraction and in the final wound epithelization between the collagen sponge seeded with and without fibroblasts. Both collagen sponges with and without fibroblasts developed neo-dermal structure without any specific immunological reaction. However, the fibroblast-seeded collagen sponge grafts showed significant re-epithelization along the junctional surface between the collagen sponge and the STSG by out-growing of the hair follicle cells. This epithelization seemed to result in formation of epithelial inclusion cysts in the neo-dermis. It was suggested that the seeded fibroblasts strongly induced such an epithelial outgrowth. The cultured collagen sponge may have beneficial effect on re-epithelization in a certain type of simultaneous skin graft overlay such as meshed STSG. 原 著

Dermal Substitute for Reconstruction of Large Full Thickness Scalp Defect: a Case of Dermal Regeneration without Removal of the Outer Table of the Skull

Dermal Substitute for Reconstruction of Large Full Thickness Scalp Defect: a Case of Dermal Regeneration without Removal of the Outer Table of the Skull

A Novel Approach to Keloid Reconstruction with Bilaminar Dermal Substitute and Epidermal Skin Grafting.

Keloids represent a challenging problem. Surgical excision remains the definitive treatment for immediate lesion debulking, but recurrence rates are reported to be 45 to 100 percent. The authors present a staged reconstructive approach using a dermal regeneration substrate and epidermal grafting to minimize recurrence and donor-site morbidity. Keloids were completely excised down to normal subcutaneous tissue or perichondrium. A bilaminar dermal regeneration matrix was approximated to the entire wound, with the silicone lamina oriented superficially. Reconstruction was delayed for at least 21 days to allow for neodermal ingrowth. The silicone lamina was then removed, and an epidermal skin graft was harvested from the thigh and secured to the neodermis with nonocclusive dressing. Reconstructed defects and donor sites were assessed for recurrence of keloids and scar appearance. Five patients underwent treatment; two had keloids involving the superior helix of the ear (average area, 2.6 cm), two had keloids involving the chest (average area, 28 cm), and one had a keloid in the pubic region (area, 10 cm). All had failed at least one previous treatment with direct excision and steroid injections. Mean follow-up was 48.8 weeks (range, 38 to 60 weeks). Average time to complete wound epithelialization was 5.5 weeks. There were no infections or cellulitis. All reconstructed defects were aesthetically acceptable and remained flat without significant widening. There were no long-term complaints of pruritus or pain and there was no evidence of donor-site scarring. Epidermal grafting provides significant advantages when used with a dermal regeneration matrix. This approach obviates reliance on skin creep and flap undermining to achieve primary closure. Exclusion of dermis and significant extracellular matrix components limits contracture, further facilitating tension-free wound healing. Scarring response within the donor site and graft is also minimized. Therapeutic, IV.

Preparation and In Vitro Evaluation of Electrochemically-Aligned Collagen Matrix as a Dermal Substitute

ABSTRACTDue to injuries and disease, there is a great need for a robust, biocompatible, biodegradable, skin-like dermal substitute to repair and regenerate damaged or lost skin. A novel electrochemical process was used to fabricate planarly aligned, densely packed collagen-based sheet which closely mimics the major structure of collagen in skin. The collagen matrix was characterized by scanning electron microscopy (SEM), oxygen permeation, moisture vapor transmission rate (MVTR), and mechanical strength. The seeding and proliferation of adipose derived stem cells (ADSCs) on the matrix was also evaluated. The results indicate that electrochemically-aligned collagen matrix has good MVTR, superior oxygen permeability, and is robust and biocompatible. Thus, it will be evaluated in vivo in the near future as a dermal substitute material.

Fabrication of duck’s feet collagen–silk hybrid biomaterial for tissue engineering

Collagen constituting the extracellular matrix has been widely used as biocompatible material for human use. In this study, we have selected duck’s feet for extracting collagen. A simple method not utilizing harsh chemical had been employed to extract collagen from duck’s feet. We fabricated duck’s feet collagen/silk hybrid scaffold for the purpose of modifying the degradation rate of duck’s feet collagen. This study suggests that extracted collagen from duck’s feet is biocompatible and resembles collagen extracted from porcine which is commercially used. Duck’s feet collagen is also economically feasible and it could therefore be a good candidate as a tissue engineering material. Further, addition of silk to fabricate a duck’s feet collagen/silk hybrid scaffold could enhance the biostability of duck’s feet collagen scaffold. Duck’s feet collagen/silk scaffold increased the cell viability compared to silk alone. Animal studies also showed that duck’s feet collagen/silk scaffold was more biocompatible than silk alone and more biostable than duck’s feet or porcine collagen alone. Additionally, the results revealed that duck’s feet collagen/silk hybrid scaffold had high porosity, cell infiltration and proliferation. We suggest that duck’s feet collagen/silk hybrid scaffold could be used as a dermal substitution for full thickness skin defects.