Reconstruction of hand surgical wounds after pseudo-syndactyly correction or squamous cell carcinoma resection in patients affected from epidermolysis bullosa: a monocentric experience with a collagen-elastin dermal matrix substitute

In patients with epidermolysis bullosa (EB), surgery may be required to remove squamous cell carcinoma (SCC) of the hands or to correct pseudo-syndactyly. Dermal substitutes may represent a suitable tool to promote the healing of surgical wounds in EB. We review our experience with a collagen-elastin dermal matrix to promote surgical wound healing due to hand surgery to correct pseudo-syndactyly or SCC resection in patients affected by EB. Overall, 12 patients (mean age, 29±11 years, range 13-51; four females) with EB were considered, with a total of 25 different interventions (16 SCC removals; 3 amputations for recurrent infiltrating SCC; 6 pseudo-syndactyly corrections). All patients received a collagen-elastin dermal matrix sheet. Neodermis was achieved in all patients, and no adverse events potentially associated with the graft occurred. No SCC recurrence was reported at sites operated for either SCC resection or amputation. The opening of the first or second commissure appears to be maintained for over 1 year after the procedure, preserving digital function. We believe that the application of a dermal substitute, together with a close dressing protocol, may represent a suitable strategy for obtaining physiological tissue regeneration and maintaining proper hand function in patients with EB.

Treatment of complex extremity wounds with MatriDerm: first clinical experience in the US

OBJECTIVE

Coverage of upper and lower extremity wounds with exposed vital structures such as tendon and bone is reliant on pedicled and free flaps. However, a population of patients with medical comorbidities or other social issues may not be suitable for flap coverage. We present the first in patient clinical experience in the US with MatriDerm (Billerbeck, Germany) for treatment of difficult extremity wounds, all with exposed bone or tendon.

METHOD

MatriDerm dermal matrix has been popular in Europe for coverage of wounds. However, MatriDerm only received full approval for use by the US Food and Drug Administration (FDA) in 2021. Here we review our clinical experience.

RESULTS

Locations (n=11) treated included forearm (n=1), hand (n=4), leg (n=3), and feet (n=3). Vital structures in wounds exposed included bone (n=3), bone and tendon (n=1), and tendon (n=7). Mean area of the wound treated was 59.2cm² (range: 2 to 230). In our series, eight out of 11 wounds healed, with MatriDerm only (n=6) or following delayed skin grafting (n=2). Mean time to healing in the patients treated only with MatriDerm was 49 days (range 7 to 84). Mean time to split-thickness skin grafting in the remaining two patients was 44.5 days (range 32 to 57).

CONCLUSION

MatriDerm has potential for treatment of complex extremity wounds, which would otherwise require flap coverage, in patients who are not good candidates for flap surgery.

Bioactive Anti-inflammatory, Antibacterial, Antioxidative Silicon-Based Nanofibrous Dressing Enables Cutaneous Tumor Photothermo-Chemo Therapy and Infection-Induced Wound Healing

Traditional skin tumor surgery and chronic bacterial-infection-induced wound healing/skin regeneration is still a challenge. The ideal strategy should eliminate the tumor, enhance wound healing/skin formation, and be anti-infection. Herein, we designed a multifunctional elastomeric poly(l-lactic acid)-poly(citrate siloxane)-curcumin@polydopamine hybrid nanofibrous scaffold (denoted as PPCP matrix) for tumor-infection therapy and infection-induced wound healing. The PPCP matrix showed intrinsically multifunctional properties including antioxidative, anti-inflammatory, photothermal, antibacterial, anticancer, and angiogenesis bioactivities. The polydopamine/curcumin presented an excellent near-infrared photothermal/cancer cell toxicity capacity, respectively, which supported PPCP for synergetic skin tumor therapy and antibacterial properties in vitro/in vivo. Additionally, the PPCP nanofibrous matrix significantly promotes the adhesion and proliferation of normal skin cells and accelerates the cutaneous wound healing in normal mice and bacterial-infected mice by enhancing the early angiogenesis. The PPCP nanofibrous matrix with multifunctional bioactivities provides a competitive strategy for skin tumor and bacterial-infection-induced wound healing.