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. 2023 Sep 7;44(5):1100-1109.
doi: 10.1093/jbcr/irad024.

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

Kathryn Dickson  1 , Kwang Chear Lee  1   2   3 , Abdulrazak Abdulsalam  1   2 , Ezekwe Amirize  1   2 , Hadyn K N Kankam  1   3 , Britt Ter Horst  1   2 , Fay Gardiner  1   2 , Amy Bamford  1   2 , Rahul K Hejmadi  1 , Naiem Moiemen  1   2   3
Affiliations

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

Kathryn Dickson et al. J Burn Care Res. .

Abstract

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 (SSG). 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 SSG. MatriDerm® integration and skin graft take were assessed with serial biopsies performed at weeks 1, 2, 3, and 4 and months 2, 3, 6, 9, and 12. Biopsies were assessed with standard special stains and immunohistochemistry, and representative slides were imaged with a transmission electron microscope. Patient satisfaction and clinical scar outcome were assessed with the Vancouver Scar Scale 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 2 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.

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Figures

Figure 1.
Figure 1.
Surgical application of MatriDerm from a single patient (M05): A. Preoperative appearance with scar contracture; B. Wound bed preparation; C. MatriDerm® application; D. SSG application; and E. Month 3.
Figure 2.
Figure 2.
MatriDerm® histology at ×10 magnification using Orcein staining with accompanying clinical appearance from a single patient (M05): A. Week 1 histology; B. Week 1 clinical appearance; C. Week 2 histology; D. Week 2 clinical appearance; E. Week 3 histology; F. Week 3 clinical appearance; G. Week 4 histology; H. Week 4 clinical appearance; I. Month 2 histology; and J. Month 2 clinical appearance. MatriDerm® layer integrity is preserved up to week 2 and shows distortion and fragmentation from week 3 onwards. At month 2, MatriDerm is entirely replaced by neodermis.
Figure 3.
Figure 3.
Total dermal thickness with varying contributions of the skin graft dermis, MatriDerm® and neodermis in: A. Actual thickness (mm); B. Percentage of total dermal thickness (%).
Figure 4.
Figure 4.
Mean vessel size and density over the initial four weeks after its application.
Figure 5.
Figure 5.
Transmission electron microscope images of MatriDerm® within the wound at direct magnification ×1900: A. MatriDerm® collagen bundles are larger in size compared to native collagen; B. Fragments of MatriDerm® are seen dispersed within the extracellular matrix during late stage of scar maturation; C. Macrophage observed engulfing bundles of MatriDerm® collagen.
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