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. 2024 Aug 23;12(8):e6094.
doi: 10.1097/GOX.0000000000006094. eCollection 2024 Aug.

A Composite Application Technique of Single-stage Dermal Templates to Improve Handling and Ease of Use

Joanneke Maitz  1   2   3 , Lucas G Carelli  1 , Elizabeth Coady  3 , Duncan Loi  1 , Peter Maitz  1   2   3
Affiliations

A Composite Application Technique of Single-stage Dermal Templates to Improve Handling and Ease of Use

Joanneke Maitz et al. Plast Reconstr Surg Glob Open. .

Abstract

The "work horse" for the treatment of full-thickness defects of any etiology, including chronic nonhealing wounds and traumatic injuries, is generally autologous split-thickness skin grafts (STSGs), meshed, hand-fenestrated, or a sheet graft. Advancements in skin tissue engineering have allowed for the integration of dermal substitutes to be combined with autologous STSGs, adding valuable options for restoring the skin's complex multilayered structure. Although dermal templates offer a promising avenue for more nuanced reconstruction in certain cases, their application is not without challenges, particularly when they are made from delicate materials. The following technique simplifies the application technique of single-stage dermal templates by using a composite approach. To demonstrate this technique, MatriDerm, a 1-mm-thick bovine collagen-elastin dermal template, is used to enable an STSG to be applied in a one-stage procedure.

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Conflict of interest statement

The authors have no financial interest to declare in relation to the content of this article.

Figures

Fig. 1.
Fig. 1.
Preparing composite MatriDerm STSG. Placement of MatriDerm on the dermal side of a meshed STSG that is resting on the carrier it was meshed on. The pores of the meshed STSG have been expanded slightly by spreading the STSG on the carrier before applying the MatriDerm. Another MatriDerm piece is already present on the STSG which has absorbed moisture from the STSG. As soon as MatriDerm is placed on the STSG, it starts to absorb the moisture from the STSG and will turn from a white construct into a translucent structure. Gentle pressure of the MatriDerm onto the STSG to assist moisture uptake of the MatriDerm can be applied using the back of a pair of forceps.
Fig. 2.
Fig. 2.
Cutting to size of composite MatriDerm STSG. Cutting to size of composite MatriDerm STSG is easy, as the moisture uptake of the MatriDerm from the STSG generates a cohesive composite structure between the dermal template and STSG, where the MatriDerm becomes adherent to the STSG due to surface tension. Full moisture uptake of MatriDerm on both pieces. Handling of the composite MatriDerm STSG is the same as the handling of an STSG alone.
Fig. 3.
Fig. 3.
Application of composite MatriDerm STSG to well-vascularized wound bed. Complete adherence of MatriDerm to STSG allows for ease of handling when applying it to the wound bed. Due to the high surface tension between the MatriDerm and the STSG, the risk of shearing MatriDerm or fragile dermal templates is reduced.
Fig. 4.
Fig. 4.
Placement of MatriDerm STSG composite in normal saline 0.9% will allow detachment of MatriDerm from STSG, without any shear or damage to the MatriDerm or STSG.
See this image and copyright information in PMC

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