Masterclass Guides: Biological Dermal Matrix: MatriDerm®

September - October 2022

Masterclass GUIDES

Introduction

This Masterclass Guide is a concise overview aimed at exploring the use of a biological dermal matrix and how to incorporate this into your practice.

Biological Dermal Matrix: MatriDerm®

Keywords

■ Biological dermal matrix

■ Regenerative healing

■ MatriDerm®

■ Wound repair

What Is MatriDerm®?

■ MatriDerm® is a unique collagen-elastin-template, which serves as a dermal replacement scaffold and can be applied both in a one and twostep procedure

■ MatriDerm® Dermal Matrix provides a native three-dimensional collagen elastin matrix to facilitate cell migration and to promote the regeneration of neo-dermis

■ Fibroblasts are guided by the native collagen elastin scaffold ensuring structured healing and formation of a neodermis

■ Enhanced neoangiogenesis and formation of microvessels ensures optimal split-thickness skin graft take1

How MatriDerm® Works

■ In a one or two step procedure, MatriDerm® Dermal Matrix is placed on the wound bed and covered with a secondary dressing or graft of choice (e.g., split-thickness skin graft)

■ Dry application of MatriDerm® is recommended. If more than one sheet of MatriDerm® is used, the sheets should overlap by approximately 2–3mm.

■ Note that there is no need to fenestrate the lyophilized sheet of MatriDerm®

■ MatriDerm® is rehydrated in the wound bed using saline or Ringer’s solution, not warmer than room temperature. The clinician ensures MatriDerm® evenly adheres to the wound bed, and air bubbles are gently removed.

■ Bolster for compression and splintage to minimize movement between wound bed and MatriDerm®

■ Negative Pressure Therapy (NPWT) may be used to optimize adherence of the collagen elastin matrix by stimulating blood vessel sprouting (vascularization) and cell proliferation (e.g., to reduce the area of exposed structures like tendons or bones)2

■ Complex wounds

■ Reconstruction

■ Dermal matrix

■ Wound

■ Wounds

1 Dry application of MatriDerm® is recommended. Trim roughly to fit the skin defect

2 Rehydrate in wound bed using saline or Ringer’s solution. Please ensure the solution is not warmer than room temperature

3 Make sure MatriDerm® evenly adheres to the wound bed. Gently remove air bubbles

4 Use STSG with optimal thickness of 0.006inch or 0.2mm

5 Mesh the STSG if necessary (e.g. limited donor site availability). Less extension leads to better aesthetic results

6 Ensure direct contact between the matrix and the skin graft; Ensure there is no gap between the wound edge and STSG

7 Attach MatriDerm® and STSG using surgeon’s preferred fixation method (e.g. sutures, staples or fibrin glue)

8 If more than one piece of MatriDerm® is required, it is advisable to have the seams of the STSG at right angles to the MatriDerm® seams

9 Place a non-adherent wound contact layer (e.g. gauze, Sorbion Plus, ADAPTIC, Mepitel) on top of STSG with 1cm skin overlap

10 If required you may additionally use an antimicrobial dressing (e.g. silver impregnated dressing) to prevent infection16

Figure 1: MatriDerm®

Click for MatriDerm® wound preparation and full application guide

Biological Dermal Matrix: MatriDerm®

What Types of Wounds Are Suitable?

■ Burns / Reconstructive

■ Burns / Acute

■ Trauma and Acute Wounds

■ Chronic Wounds

■ Cancer Excision

■ Adhesion Barrier

■ Donor Sites

■ Mucosal Defects4

Figure 2a: In a One or Two Step Procedure, MatriDerm® Dermal Matrix is placed on the wound bed and covered with a secondary dressing of choice (e.g. split-thickness skin graft).

Figure 2b: Fibroblasts are guided by the native collagen elastin scaffold ensuring structured healing and formation of a neodermis.

Figure 2c: MatriDerm® Dermal Matrix provides a native three-dimensional collagen elastin matrix to facilitate cell migration and guided healing.

Figure 2d: Enhanced neo-angiogenesis and formation of microvessels ensuring supply and optimal split-thickness skin graft take.

Masterclass GUIDES

What Is the Evidence?

MatriDerm® is able to preserve closeness to human dermis, accelerate cell invasion, cell elongation and proliferation and limit myofibroblast formation and contraction5. This scientific performance is as a result of the Advanced CryoSafe® Method which gently preserves the native structure with no chemical crosslinking6.

Efficacy Quality of Wound Healing

■ In an animal AV-Loop model, a number of new formed blood vessels were analyzed in wounds treated with either with MatriDerm® Dermal Matrix or a competitor product. MatriDerm® Dermal Matrix accelerates revascularization7

■ MatriDerm® Dermal Matrix limits myofibroblast formation compared to competitor products5 Myofibroblast formation is associated with wound contraction8. Limited wound contraction is observed with MatriDerm®9,10,11

■ MatriDerm® ensures active healing. In diabetic foot ulcers the combination of MatriDerm® with STSG leads to a shorter healing period compared to STSG alone12

■ A long term follow-up study of an intra-individual comparison of patients treated with STSG alone, and with MatriDerm® Dermal Matrix and STSG, to analyze different skin parameters after 12 years of treatment, demonstrated a long lasting effect on scar quality even after 12 years by the use of MatriDerm® Dermal Matrix, compared to STSG alone13

Costs

■ In an RCT the total surgical treatment costs of Full-thickness wounds treated with STSG alone or with MatriDerm® Dermal Matrix and STSG were analyzed. The costs do not differ significantly14

“The native dermis-like collagen fibrillar networks exhibit premium properties for cell ingrowth, survival, and proliferation... by balancing the expression of myofibroblasts, they lead to decreased wound contraction and aberrant scar formation5.”

“FTSG with MatriDerm® improves the DASH score and the aesthetic outcomes resulting to be a reliable solution in treating full thickness forearm skin defects after RFF harvesting15.”

Key Points

References

1. Flexible solutions for complex wound reconstruction. Medskin Solutions Dr. Suwelack AG. [Internet]. Available from https://www.gdmedical.nl/wp-content/uploads/2020/10/89575_009_MD-Case_Brochure_new-CI.pdf. [Accessed 20/09/2022].

2. Panayi AC, Leavitt T, Orgill DP. Evidence based review of negative pressure wound therapy. World J Dermatol 2017; 6(1): 1-16. DOI: 10.5314/wjd.v6.i1.1

3. MatriDerm - Application Video – Amputated Forefoot – One-Step Procedure. [Internet]. Available from https://www.youtube.com/watch?v=oE4QHuKduPA. [Accessed 20/09/2022].

4. MatriDerm® - MedSkin Solutions Dr. Suwelack AG. [Internet]. Available from https://matriderm.com/en. [Accessed 20/09/2022].

5. Dill V, Mörgelin M. Biological dermal templates with native collagen scaffolds provide guiding ridges for invading cells and may promote structured dermal wound healing. Int Wound J. 2020 Jun;17(3):618-630. DOI: 10.1111/iwj.13314. Epub 2020 Feb 11. PMID: 32045112; PMCID: PMC7949003.

6. Böhm, S., Strauß, C., Stoiber, S., Kasper, C., and Charwat, V. 2017. ‘Impact of Source and Manufacturing of Collagen Matrices on Fibroblast Cell Growth and Platelet Aggregation’, Materials, 10(9). 1086; DOI: https://doi.org/10.3390/ ma10091086

7. Schmidt VJ, Wietbrock JO, Leibig N, Gloe T, Henn D, Hernekamp JF, Harhaus L, Kneser U. Collagen-Elastin and Collagen-Glycosaminoglycan Scaffolds Promote Distinct Patterns of Matrix Maturation and Axial Vascularization in Arteriovenous Loop-Based Soft Tissue Flaps. Ann Plast Surg. 2017 Jul;79(1):92-100. DOI: 10.1097/SAP.0000000000001096. PMID: 28542070.

8. Kattan WM et al., J Coll Physicians Surg Pak 2017;27:38-43.

9. de Vries HJ, Middelkoop E, Mekkes JR, Dutrieux RP, Wildevuur CH, Westerhof H. Dermal regeneration in native non-cross-linked collagen sponges with different extracellular matrix molecules. Wound Repair Regen. 1994 Jan;2(1):37-47. DOI: 10.1046/j.1524-475X.1994.20107.x. PMID: 17168910.

10. De Vries HJ, Zeegelaar JE, Middelkoop E, Gijsbers G, Van Marle J, Wildevuur CH, Westerhof W. Reduced wound contraction and scar formation in punch biopsy wounds. Native collagen dermal substitutes. A clinical study. Br J Dermatol. 1995 May;132(5):690-7. DOI: 10.1111/j.1365-2133.1995.tb00712.x. PMID: 7772472.

11. Hur GY, Seo DK, Lee JW. Contracture of skin graft in human burns: effect of artificial dermis. Burns. 2014 Dec;40(8):1497-503. DOI: 10.1016/j.burns.2014.08.007. Epub 2014 Sep 28. PMID: 25270084.

12. Jeon H, Kim J, Yeo H, Jeong H, Son D, Han K. Treatment of diabetic foot ulcer using matriderm in comparison with a skin graft. Arch Plast Surg. 2013 Jul;40(4):403-8. DOI: 10.5999/aps.2013.40.4.403. Epub 2013 Jul 17. PMID: 23898439; PMCID: PMC3724003.

13. Bloemen MCT, van Leeuwen MCE, van Vucht NE, van Zuijlen PPM, Middelkoop E. Dermal substitution in acute burns and reconstructive surgery: a 12-year follow-up. PlastReconstr Surg. 2010 May;125(5):1450-1459. DOI: 10.1097/ PRS.0b013e3181d62b08. PMID: 20440164.

14. Hop MJ, Bloemen MC, van Baar ME, Nieuwenhuis MK, van Zuijlen PP, Polinder S, Middelkoop E; TOPSKIN Study Group. Cost study of dermal substitutes and topical negative pressure in the surgical treatment of burns. Burns. 2014 May;40(3):388-96. DOI: 10.1016/j.burns.2013.08.025. Epub 2013 Sep 13. PMID: 24035577.

15. Cristofari S, Guenane Y, Atlan M, Hallier A, Revol M, Stivala A. Coverage of radial forearm flap donor site with full thickness skin graft