Download PDF
CC BY-NC-ND 4.0 · Indian J Plast Surg 2018; 51(01): 046-053
DOI: 10.4103/ijps.IJPS_217_17
Original Article
Association of Plastic Surgeons of India

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

Giovanni Nicoletti
1   Department of Clinical Surgical Diagnostic and Pediatric Sciences, Plastic and Reconstructive Surgery Unit, University of Pavia, Italy
2   Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Italy
,
Marco Mario Tresoldi
1   Department of Clinical Surgical Diagnostic and Pediatric Sciences, Plastic and Reconstructive Surgery Unit, University of Pavia, Italy
2   Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Italy
,
Alberto Malovini
3   Laboratory of Informatics and Systems Engineering for Clinical Research, Maugeri Clinical Scientific Institutes, University of Pavia, Pavia, Italy
,
Marco Visaggio
1   Department of Clinical Surgical Diagnostic and Pediatric Sciences, Plastic and Reconstructive Surgery Unit, University of Pavia, Italy
,
Angela Faga
4   Plastic and Reconstructive Surgery Unit, Maugeri Clinical Scientific Institutes, University of Pavia, Pavia, Italy
5   Department of Molecular Medicine, University of Pavia, Pavia, Italy
,
Silvia Scevola
2   Advanced Technologies for Regenerative Medicine and Inductive Surgery Research Center, University of Pavia, Italy
› Author Affiliations
Further Information

Publication History

Publication Date:
26 July 2019 (online)

Also available at
   Permissions and Reprints

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.

KEY WORDS

Clinical application - collagen - dermal substitutes - hyaluronan - skin reconstruction
 

  • REFERENCES

  • 1 Wolter TP, Noah EM, Pallua N. The use of integra in an upper extremity avulsion injury. Br J Plast Surg 2005; 58: 416-8
    CrossrefPubMedSearch in Google Scholar
  • 2 Weigert R, Choughri H, Casoli V. Management of severe hand wounds with integra® dermal regeneration template. J Hand Surg Eur Vol 2011; 36: 185-93
    CrossrefPubMedSearch in Google Scholar
  • 3 Heimbach D, Luterman A, Burke J, Cram A, Herndon D, Hunt J. et al. Artificial dermis for major burns. A multi-center randomized clinical trial. Ann Surg 1988; 208: 313-20
    CrossrefPubMedSearch in Google Scholar
  • 4 Groos N, Guillot M, Zilliox R, Braye FM. Use of an artificial dermis (Integra) for the reconstruction of extensive burn scars in children. About 22 grafts. Eur J Pediatr Surg 2005; 15: 187-92
    Thieme ConnectPubMedSearch in Google Scholar
  • 5 Gravante G, Delogu D, Giordan N, Morano G, Montone A, Esposito G. et al. The use of hyalomatrix PA in the treatment of deep partial-thickness burns. J Burn Care Res 2007; 28: 269-74
    CrossrefPubMedSearch in Google Scholar
  • 6 Motolese A, Vignati F, Brambilla R, Cerati M, Passi A. Interaction between a regenerative matrix and wound bed in nonhealing ulcers: Results with 16 cases. Biomed Res Int 2013; 2013: 849321
    PubMedSearch in Google Scholar
  • 7 Nicoletti G, Scevola S, Faga A. Bioengineered skin for aesthetic reconstruction of the tip of the nose: A case report. Dermatol Surg 2008; 34: 1283-7
    CrossrefPubMedSearch in Google Scholar
  • 8 Faga A, Nicoletti G, Brenta F, Scevola S, Abatangelo G, Brun P. et al. Hyaluronic acid three-dimensional scaffold for surgical revision of retracting scars: A human experimental study. Int Wound J 2013; 10: 329-35
    CrossrefPubMedSearch in Google Scholar
  • 9 Nicoletti G, Brenta F, Bleve M, Pellegatta T, Malovini A, Faga A. et al. Long-term in vivo assessment of bioengineered skin substitutes: A clinical study. J Tissue Eng Regen Med 2015; 9: 460-8
    CrossrefPubMedSearch in Google Scholar
  • 10 Morozzo U, Villafañe JH, Ieropoli G, Zompi SC, Cleland JA, Navissano M. et al. Soft tissue reconstructions with dermal substitutes versus alternative approaches in patients with traumatic complex wounds. Indian J Surg 2015; 77: 1180-6
    CrossrefPubMedSearch in Google Scholar
  • 11 Brookes M, Revell WJ. Blood supply of flat bones. Bones of the skull. In: Brookes M, Revell WJ. editors. Blood Supply of Bone. Scientific Aspects. London: Springer Verlag; 1998: p. 66
    Search in Google Scholar
  • 12 Chen WY, Abatangelo G. Functions of hyaluronan in wound repair. Wound Repair Regen 1999; 7: 79-89
    CrossrefPubMedSearch in Google Scholar
  • 13 Presti D, Scott JE. Hyaluronan-mediated protective effect against cell damage caused by enzymatically produced hydroxyl (OH.) radicals is dependent on hyaluronan molecular mass. Cell Biochem Funct 1994; 12: 281-8
    CrossrefPubMedSearch in Google Scholar
  • 14 Kvam BJ, Fragonas E, Degrassi A, Kvam C, Matulova M, Pollesello P. et al. Oxygen-derived free radical (ODFR) action on hyaluronan (HA), on two HA ester derivatives, and on the metabolism of articular chondrocytes. Exp Cell Res 1995; 218: 79-86
    CrossrefPubMedSearch in Google Scholar
  • 15 Fukuda K, Takayama M, Ueno M, Oh M, Asada S, Kumano F. et al. Hyaluronic acid inhibits interleukin-1-induced superoxide anion in bovine chondrocytes. Inflamm Res 1997; 46: 114-7
    CrossrefPubMedSearch in Google Scholar
  • 16 Wang H, Pieper J, Péters F, van Blitterswijk CA, Lamme EN. Synthetic scaffold morphology controls human dermal connective tissue formation. J Biomed Mater Res A 2005; 74: 523-32
    PubMedSearch in Google Scholar
  • 17 Michaeli D, McPherson M. Immunologic study of artificial skin used in the treatment of thermal injuries. J Burn Care Rehabil 1990; 11: 21-6
    CrossrefPubMedSearch in Google Scholar
  • 18 Philandrianos C, Andrac-Meyer L, Mordon S, Feuerstein JM, Sabatier F, Veran J. et al. Comparison of five dermal substitutes in full-thickness skin wound healing in a porcine model. Burns 2012; 38: 820-9
    CrossrefPubMedSearch in Google Scholar
  • 19 Janis JE, Kwon RK, Attinger CE. The new reconstructive ladder: Modifications to the traditional model. Plast Reconstr Surg 2011; 127 (Suppl. 01) 205S-12S
    CrossrefPubMedSearch in Google Scholar