Long-term experience with a collagen-elastin scaffold in combination with split-thickness skin grafts for the treatment of full-thickness soft tissue defects: improvements in outcome—a retrospective cohort study and case report

Abstract

Purpose The management of severe soft tissue injuries to the extremities with full-thickness wounds poses a challenge to the patient and surgeon. Dermal substitutes are used increasingly in these defects. The aim of this study was to investigate the impact of the type of injury on the success rate of Matriderm® (MD)-augmented split-thickness skin grafting, as well as the role of negative pressure wound therapy (NPWT) in preconditioning of the wounds, with a special focus on the reduction of the bioburden. Methods In this study, 45 wounds (44 affecting lower extremities (97.7%)), resulting from different types of injuries: soft tissue (ST), soft tissue complications from closed fracture (F), and open fracture (OF) in 43 patients (age 55.0 ± 18.2 years, 46.7% female), were treated with the simultaneous application of MD and split-thickness skin grafting. The study was designed as a retrospective cohort study from March 2013 to March 2020. Patients were stratified into three groups: ST, F, and OF. Outcome variables were defined as the recurrence of treated wound defects, which required revision surgery, and the reduction of bioburden in terms of reduction of number of different bacterial strains. For statistical analysis, Student’s t-test, analysis of variance (ANOVA), Mann–Whitney U test, and Pearson’s chi-squared test were used. Results There was no significant difference in the rate of recurrence in the different groups (F: 0%; OF: 11.1%; ST: 9.5%). The duration of VAC therapy significantly differed between the groups (F: 10.8 days; OF: 22.7 days; ST: 12.6 days (p < 0.05)). A clinically significant reduction of bioburden was achieved with NPWT (bacterial shift (mean (SD), F: − 2.25 (1.89); OF: − 1.9 (1.37); ST: − 2.6 (2.2)). Conclusion MD-augmented split-thickness skin grafting is an appropriate treatment option for full-thickness wounds with take rates of about 90%. The complexity of an injury significantly impacts the duration of the soft tissue treatment but does not have an influence on the take rate. NPWT leads to a relevant reduction of bioburden and is therefore an important part in the preconditioning of full-thickness wounds.

Management of Hardware-Exposed Soft Tissue Defects Using Dermal Substitutes and Negative Pressure Wound Therapy

“…Recently, studies showing a high success rate when combined treatment with dermal matrix and NPWT were performed before skin grafting were published 8–10 . It has been reported that NPWT can accelerate the integration of artificial dermis into the wound bed and provide controlled continuous or intermittent subatmospheric pressure 10 .…”

“…Recently, studies showing a high success rate when combined treatment with dermal matrix and NPWT were performed before skin grafting were published. [8][9][10] It has been reported that NPWT can accelerate the integration of artificial dermis into the wound bed and provide controlled continuous or intermittent subatmospheric pressure. 10 Although researchers have shown that combination therapy can help increase graft acceptance in difficult-to-treat wounds, none of these studies have been applied to postoperative hardware exposure.…”

“…Several studies have shown good results for use in severe complex wounds accompanied by tendon or bone exposure. In addition, studies have shown better results when combined treatment with negative pressure wound therapy (NPWT) and artificial dermal substitutes is performed after extensive surgical debridement and management of NPWT 8,9 …”

“…10 However, flaps have problems such as higher risks of complications and morbidity of both acceptor and donor sites, unique difficulties specific to flap procedures, and limitations of the reconstruction range. 9,11 Systemic factors can also affect flap survival; hypovolemia can lead to flap hypoperfusion, hypothermia can lead to vasoconstriction, and arteriosclerosis can significantly affect the quality of recipient's vessels, thereby decreasing blood supply to the flap, especially in the lower extremity. 12 Therefore, we attempted to prove the usefulness of a combined treatment using artificial dermal substitutes (MatriDerm) and NPWT.…”

“…In addition, studies have shown better results when combined treatment with negative pressure wound therapy (NPWT) and artificial dermal substitutes is performed after extensive surgical debridement and management of NPWT. 8,9 However, a serious soft tissue defect in a region such as the anteromedial surface of the leg or malleolus, not having a muscular bed and covered with only a thin layer of skin and subcutaneous fat, easily deteriorates to an intractable soft tissue defect. In particular, when these areas are accompanied by fractures and internal fixation using a plate is performed, soft tissue defects are likely to occur because of skin necrosis, and hardware is frequently exposed.…”