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      A Previously Discounted Flap Now Reconsidered: MatriDerm and Split-Thickness Skin Grafting for Tendon Cover Following Dorsalis Pedis Fasciocutaneous Flap in Lower Limb Trauma

      case-report
      Author(s): , MBChB, MRCS a , , MBChB, MRCS b , , MBChB, MPhil, FRCS (Plast) c
      Publication date (Electronic):
      Journal: Eplasty
      Publisher: Open Science Company, LLC
      Keywords: dorsalis pedis flap, reconstruction, MatriDerm, skin, lower limb trauma

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          Abstract

          Objective: The dorsalis pedis flap has reliable vascularity; however, its use is limited by reports of donor site morbidity including infection, delayed healing, exposure of tendons, and later contractures. The purpose of this study was to demonstrate its continued role in lower limb trauma when the donor site is reconstructed with MatriDerm to avoid complications. Methods: A 65-year-old man presented with a displaced, Gustilo 3b open transverse fracture of his left distal fibula. He had a 2 cm 2 open wound over his lateral malleolus. Results: Following review of possible local options, a dorsalis pedis fasciocutaneous flap was deemed best for coverage, and the donor site was closed with 1-mm MatriDerm dermal matrix and a 6/1000 inch split-thickness skin graft (STSG) in a single stage. Three months postoperatively, the foot had excellent function and cosmesis, with toes in a neutral position and a full range of movement. Conclusions: The dorsalis pedis flap is a valuable reconstructive option for defects of the foot and ankle. Its major limitation donor site morbidity can be overcome by the additional application of a dermal substitute such as MatriDerm under the STSG.

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          Most cited references5

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          The use of MatriDerm in early excision and simultaneous autologous skin grafting in burns--a pilot study.

          H Ryssel, E Gazyakan, G Germann … (2008)
          The application of dermal substitutes in deep partial and full-thickness burn wounds in a two-stage procedure prior to skin grafting has become increasingly popular. Synchronous application of dermal substitutes and skin graft has not yet been established as a standard procedure. In a consecutive study 20 wounds in 10 patients with severe burns (age 49.5+/-16.2 years; TBSA 45.6+/-14.5%) were treated with either simultaneous transplantation of Matriderm, a bovine based collagen I, III, V and elastin hydrolysate based dermal substitute and split-thickness skin grafting (STSG), or STSG alone after appropriate excision of the burn wound. The study was designed as a prospective intra-individual comparative study. After 1 week all wounds were assessed for the percentage of autograft survival. Autograft survival was not altered by simultaneous application of a dermal matrix (p=0.015). Skin elasticity was measured after 3-4 months with the Vancouver Burn Skin Score (VBSS). The VBSS demonstrated a significant increase of elasticity in the group with dermal substitutes (p=0.04) as compared with non-substituted wounds for sheet autograft, but not for meshed autograft (p=0.24). From this pilot study it can be concluded that simultaneous application of a dermal matrix is safe and feasible, yielding significantly better results with respect to skin elasticity. Skin elasticity was considerably improved by the collagen/elastin dermal substitute Matriderm in combination with sheet autograft.
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            Management of full-thickness skin defects in the hand and wrist region: first long-term experiences with the dermal matrix Matriderm.

            W Haslik, L.-P. Kamolz, F Manna … (2010)
            The gold standard for the coverage of full-thickness skin defects is autologous skin grafts. However, poor skin quality and scar contracture are well-known problems in functional, highly strained regions. The use of dermal substitutes is an appropriate way to minimise scar contraction and, thereby, to optimise the quality of the reconstructed skin. The aim of this study was to evaluate the impact of the collagen-elastin matrix, Matriderm, for the single-step reconstruction of joint-associated defects of the upper extremity. Seventeen patients with full-thickness skin defects of the upper extremity were treated with the dermal substitute, Matriderm, and unmeshed skin graft in the functional critical region of the distal upper extremity in a single-step procedure. The take rate of the matrix-and-skin graft was 96%. Long-term follow-up revealed an overall Vancouver scar scale of 1.7. No limitation concerning hand function was observed; DASH-score analysis revealed excellent hand function in patients with burn injury and patients with a defect due to the harvest of a radial forearm flap achieved satisfying hand function. This matrix represents a viable alternative to other types of defect coverage and should therefore be considered in the treatment of skin injuries, especially in very delicate regions such as the joint regions. The possibility of performing a one-stage procedure is supposed to be a major advantage in comparison to a two-stage procedure. 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.
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              First experiences with the collagen-elastin matrix Matriderm as a dermal substitute in severe burn injuries of the hand.

              Brigitte M. Frey, H Andel, W Haslik … (2007)
              Restoring function after hand burns plays a major role in the restitution of a quality of life. Thereby the reconstructed pliability of the grafted areas is of utmost importance for good hand function. The collagen elastin matrix Matriderm was evaluated as a dermal substitute for the treatment of severe hand burns. In a series of 10 patients, mean age 43 years, TBSA 22.8%, an early debridement and immediate grafting with the matrix and unmeshed skin graft was carried out in a one-stage procedure. In the early postoperative follow up an overall take rate of 97% was observed. In contrast to conventional skin grafts, the color of the skin grafts over the matrix appeared pale in the first few days, but after 2 weeks no difference was observed. After three months, pliability of the grafted area was excellent, (mean VSS 3.2+/-1.2). Full range of motion was achieved in all hands, no blisters and no unstable or hypertrophic scars occurred. Matriderm has proved to be a dermal substitute suitable for the treatment of hand burns. We therefore consider Matriderm as a promising dermal substitute for the treatment of severe hand burns.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eplasty
                Journal ID (iso-abbrev): Eplasty
                Journal ID (publisher-id): ePlasty
                Title: Eplasty
                Publisher: Open Science Company, LLC
                ISSN (Electronic): 1937-5719
                Publication date Collection: 2014
                Publication date (Electronic): 28 April 2014
                Volume: 14
                Electronic Location Identifier: e19
                Affiliations
                [1] aDepartment of Plastic Surgery, St George's Hospital, Blackshaw Road, London, SW17 0QT, UK
                [2] bDepartment of Plastic Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK
                [3] cDepartment of Plastic Surgery and Burns, Royal Perth Hospital, Wellington Street, Perth 6000, Australia
                Author notes
                Article
                Publisher ID: 19
                PMC ID: 4006426
                SO-VID: 4c65203b-51d8-4e81-8e62-7a66b3ec0a97
                Copyright © Copyright © 2014 The Author(s)
                License:

                This is an open-access article whereby the authors retain copyright of the work. The article is distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: dorsalis pedis flap,reconstruction,matriderm,skin,lower limb trauma
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: dorsalis pedis flap, reconstruction, matriderm, skin, lower limb trauma

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