Dr Markus Öehlbauer
Head of Plastic Surgery / Burn Center; BG Trauma Center Murnau; Paracelsus Medical Private University Salzburg
Introduction
Despite successful defect coverage by means of complex skin or muscle flaps, particularly large and deep problematic wounds with exposed bradytrophic tissues after soft tissue loss are highly susceptible to surgical revision.
MatriDerm, a dermal matrix, consisting of native collagen (collagen type I, III and V) supplemented by an elastin hydolyzate was first used for the treatment of burns, predominantly those that were full-thickness. Subsequently, its use was extended to defect coverage especially after traumatic soft tissue loss.
Patients and Methods
This retrospective study included patients treated in a level I trauma center between January 2014 and December 2019 in terms of a severe soft tissue defect of upper or lower extremity using STSG in combination with acellular dermal matrix MatriDerm in a one-step procedure. The healing of the soft tissue defect was measured by assessment of the take rate. Outcome quality of the scar tissue was assessed using the Vancouver Scar Scale more than 24 months postoperatively.
Results
A total of 76 cases were included in this study. The overall healing rate (number of patients with take rate ≥ 75%) was 63/76(83%). The majority of postoperative events that had to be revised surgically included healing disturbances such as remaining defects, necrosis, or delayed healing
Regarding the VSS there was no overall difference to treatment groups after split skin grafting to exposed (and/or partial loss of) subcutaneous tissue.
Two-years follow up of these collagen-elastin matrix procedures in defect coverage showed an excellent functional outcome: Up until now, no areas with unstable scars have occurred, no surgical scar revisions were required. The patients were still able to wear normal footwear, clinical gait analysis showed perfect functional outcome.
Conclusion
The one-step application of collagen-elastin matrix MatriDerm in patients with exposed bradytrophic tissue after severe burn or traumatic injury treated so far can be recommemded as an excellent reconstruction method, independent of patient’s age or comorbidity.
Applicability of research to practice
Use of collagen-elastin matrix MatriDerm in one-step procedures in severe burn and traumatic injuries with exposed bradytrophic tissue can successfully avoid complex skin or muscle flaps and minimize the risk of major surgical revision.
Biography:
Dr. Öehlbauer received a medical degree from the Medical University of Innsbruck. He then went on to fellowships at the BG Trauma Centers in Hamburg and Ludwigshafen. After completion of plastic surgery training in Innsbruck, he moved to Burn Center Ludwigshafen/University Heidelberg as Head Consultant.
He is the current Head of Plastic Surgery and Burn Center at the BG Trauma Center Murnau in Upper Bavaria near Munich. He is a member of German Society of Burn Medicine and has been a significant driving force in the use of dermal substitutes in burn patients. He has a strong involvement in the education and training of undergraduate and graduate students and in plastic surgery training. As a plastic surgeon, he has a high interest in wound healing by dermal substitutes especially in severe injured patients.