Mark S. Lesney

Nephropathy Found to Predict Poor Diabetic Foot Outcomes

C H I C A G O — The novel skin substitutes Suprathel and Matriderm resulted in complete healing and excellent functionality in patients with deep burns in two studies. By using Suprathel, complete epithelialization was achieved in 14-20 days for 38 of 40 patients with deep dermal burns. Regrafting was necessary in only two patients, said Dr. David Lumenta, who presented the results on behalf of Dr. Lars-Peter Kamolz at the annual meeting of the American Burn Association. Both are with the division of plastic and reconstructive surgery at the Medical University of Vienna. Average total body surface area burned (TBSA) was 35%, although the team has used Suprathel (PolyMedics Innovations GmbH, Denkendorf, Germany) in patients with burns up to 90% TBSA. Suprathel is a resorbable skin substitute produced from a fully synthetic copolymer with a porous membrane, based largely (greater than 70%) on poly-DL-lactide. It is available in various pore and surface sizes and is indicated mainly for use on donor sites and partial-thickness burns. Its main advantages are reduced pain, accelerated epithelialization, and employment in functionally stressed regions and joints. It is more easily handled than other biologic dressings, and there is no biological risk, Dr. Lumenta said. No signs of local or systemic allergic reaction were observed in the 40 patients. In a poster at the same meeting, Dr. Kamolz reported their experience with Matriderm in 10 patients with severe hand burns. Matriderm (Dr. Suwelack Skin & Health Care AG, Billerbeck, Germany) is a thin, porous membrane consisting of a native bovine type I, II, and V collagen-fiber template coated with elastin hydrolysate, which is converted into native host collagen within weeks of application, Dr. Kamolz said in an interview. The matrix serves as a support structure for new cell growth while the collagen improves the stability and elasticity of the regenerating tissue. As healing progresses, fibroblasts produce their own extracellular matrix and Matriderm is resorbed. The main indications for this matrix are full-thickness burns in functionally and aesthetically important regions, he said. A two-step repair is recommended for Matriderm sheets 2 mm or greater in thickness, with a 7-day interval between matrix application and transplantation of split-thickness skin grafts to allow for vascularization of the matrix. A single operation is feasible in the acute phase after burn trauma using a 1-mm-thick sheet. The take-rate using Matriderm does not differ significantly, compared with traditional splitthickness skin grafts, and the quality of the resulting scar has been superior, Dr. Kamolz said. The take-rate was 97% at 3 months’ follow-up among 10 patients, mean age 45 years, with severe, full-thickness hand burns (TBSA 23%) who underwent early debridement and immediate grafting with Matriderm and an unmeshed skin graft in a single operation. The pliability of the grafted area was excellent, with a mean Vancouver Scar Scale score of 3.2. Full range of motion was achieved in all hands, he said. No blisters and no unstable or hypertrophic scars were observed. In comparison with conventional skin grafts, the color of the skin grafts over the matrix appeared pale during the first few days, but no difference was observed after 2 weeks. “These good functional and aesthetic results remain stable, even 12 months postoperatively,” he reported. The study was supported by the Medical University of Vienna. The investigators disclosed no relevant conflicts of interest. Neither product has been approved for use in the United States. ■ P H O T O S C O U R T E S Y D R . L A R S -P E T E R K A M O L Z