Versatile use of dermal substitutes: A retrospective survey of 127 consecutive cases

Abstract

Background: Dermal substitutes are currently largely used for the treatment of huge skin loss in patients in critical general health conditions, for the treatment of severe burns and to promote the healing process in chronic wounds.

Aims: The authors performed a retrospective assessment of their experience with bioengineered skin to possibly identify the most appropriate clinical indication and management for each substitute.

Materials and methods: The study involved 109 patients with 127 skin defects repaired with dermal substitutes over a 9 years period, from 2007 to 2016. Hyalomatrix^® was used in 63 defects, whereas Integra^® and Nevelia^® were used in 56 and 8 defects, respectively.

Results: The statistical analysis failed to reveal a correlation between the choice of a specific dermal substitute and any possible clinical variable except in the soft-tissue defects of the scalp where Hyalomatrix^® was electively used.

Conclusions: In the authors' experience, the scalp defects followed a radical excision of skin tumours that included the periosteum. Here, the preliminary cover with a hyaluronan three-dimensional scaffold constantly allowed for the regeneration of a derma-like layer with a rich vascular network fit for supporting a split-thickness skin graft. Nevertheless, the authors still prefer Integra^® when the goal is a better cosmetic outcome and Hyalomatrix^® when a faster wound healing is required, especially in the management of deep wounds where the priority is a fast obliteration with a newly formed tissue with a rich blood supply. However, these clinical indications still are anecdotally based.

Keywords: Clinical application; collagen; dermal substitutes; hyaluronan; skin reconstruction.

Figure 1

Trend for the clinical use of the different dermal substitutes along the period of study

Figure 2

(a) Retracting post-burn scars in the posterior aspect of the left lower limb. (b) Soft tissue loss following scar release in the lower left gluteal area and in the left popliteal fossa. (c) The defects are temporarily repaired with Hyalomatrix^® dermal substitute. (d) Stable repair with split thickness skin grafts

Figure 3

(a) Congenital melanocytic naevus of the right temple. (b) Temporary repair with Integra^® dermal substitute following radical excision. (c) Stable repair following early engraftment of a split thickness skin graft. (d) Long-term outcome of stable split thickness skin graft

Figure 4

(a) Soft tissue loss following radical excision of locally infiltrating basal cell carcinoma of the vertex of the scalp. The defect includes the periosteum and a portion of the outer cortex of the skull bone. (b) The defect is temporarily repaired with Hyalomatrix^® dermal substitute. (c) Regeneration of a derma-like layer with a rich vascular network fit for supporting a split-thickness skin graft. (d) Stable repair with a split thickness skin graft

Figure 5

(a) Soft tissue loss following radical excision of locally infiltrating squamous cell carcinoma of the vertex of the scalp. The defect includes the periosteum in the lower left area of the excision. (b) Regeneration of a derma-like layer with a rich vascular network fit for supporting a split-thickness skin graft. (c) Long-term outcome after repair with a split-thickness skin graft. A minor area of instability is appreciated

Figure 6

(a) Post-traumatic degloving injury of the Achilles region in the right foot. (b) Soft tissue loss following the wound debridement. (c) The defect is temporarily repaired with Hyalomatrix^® dermal substitute. (d) Stable repair with a split-thickness skin graft

Figure 7

(a) Basal cell carcinoma of the dorsum of the nose. (b) Temporary repair with Integra^® dermal substitute following tumour radical excision. (c) Stable repair with a split thickness skin graft