Clinical Report: Collagen-Elastin Scaffold with Split-Thickness Grafts for Full-Thickness Defects

Overview

This retrospective cohort study evaluated the use of a collagen-elastin matrix (Matriderm®) combined with split-thickness skin grafts for full-thickness soft tissue defects. The study assessed wound complexity, the role of negative pressure wound therapy (NPWT) in preconditioning, and bacterial load dynamics, demonstrating improved graft take and wound healing outcomes.

Background

Full-thickness wounds of the extremities present significant reconstructive challenges, often requiring complex procedures beyond primary closure. Split-thickness skin grafts alone frequently yield suboptimal mechanical and cosmetic results due to insufficient dermal support. Dermal substitutes like Matriderm®, a bovine-derived collagen-elastin matrix, have been developed to enhance graft outcomes by providing a stable neo-dermis. NPWT is commonly used pre- and postoperatively to optimize wound bed conditions, reduce bacterial load, and improve graft integration.

Data Highlights

The study included patients over 16 years treated between 2013 and 2020 with Matriderm®-augmented split-thickness skin grafts and postoperative NPWT for at least 5 days. Patients were stratified by injury type: fracture, open fracture, or soft tissue injury. Data collected encompassed demographics, wound characteristics, NPWT duration, microbiological findings, antibiotic use, and clinical outcomes. Microbiological sampling was performed at multiple time points to monitor bacterial colonization and infection risk.

Key Findings

• Matriderm® combined with split-thickness skin grafts in a single-step procedure resulted in stable and elastic neo-dermis formation, improving mechanical stability and cosmetic outcomes compared to grafts alone.
• Preconditioning wounds with NPWT significantly reduced wound size, edema, and bacterial load, facilitating better graft take and reducing donor and acceptor site morbidity.
• Postoperative epicutaneous NPWT protected grafts from infection and detachment, accelerated vascularization, and enhanced graft integration.
• Positive bacterial cultures without clinical infection signs did not necessarily delay definitive wound closure, indicating that clinical assessment remains crucial.
• Broad-spectrum antibiotics were used initially in high-risk patients, with adjustments based on sensitivity testing, while clean wounds received prophylactic single-shot antibiotics.

Clinical Implications

The combination of Matriderm® with split-thickness skin grafts offers a practical and effective option for reconstructing full-thickness soft tissue defects, especially where flap surgery is not feasible. Incorporating NPWT both pre- and postoperatively optimizes wound bed conditions, reduces infection risk, and improves graft survival. Clinicians should balance microbiological findings with clinical signs when timing definitive closure to avoid unnecessary delays.

Conclusion

Matriderm®-augmented split-thickness skin grafting combined with NPWT represents a valuable reconstructive strategy for complex full-thickness wounds, enhancing functional and aesthetic outcomes while minimizing complications. Careful wound conditioning and clinical evaluation are key to successful treatment.

References

1. Medskin Dr. Suwelack Skin & Health Care AG -- Matriderm® matrix product information
2. STROBE guidelines 2007 -- Strengthening the Reporting of Observational Studies in Epidemiology
3. Various clinical studies cited (references [1]-[22]) -- Use of dermal substitutes and NPWT in wound management