SpringerLink
Log in

Evaluation of the use of an acellular dermal matrix produced in a tissue bank with and without skin autografts in burn patients: a comparative study in a Colombian population

  • Original Paper
  • Published:
European Journal of Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

The dermal matrices (DM) represent a crucial advancement in plastic and reconstructive surgery by improving functional and aesthetic outcomes in skin healing. Despite their benefits, their high cost restricts their usage. The main aim of this study was to compare the functional and aesthetic outcomes between skin autografts combined with a glycerolized acellular dermal matrix and solely skin autografts.

Methods

A prospective cohort study is presented wherein 65 areas of 30 burn patients were included, distributed into two groups. The first group involved areas exposed to the use of glycerolized acellular dermal matrix (GADM) produced in a tissue bank with autografts in the same surgical time. The second group consisted of areas with sole skin autografts. A 6-month follow-up was conducted to compare functional and aesthetic outcomes.

Results

The comparative statistical analysis demonstrates, with a significant level of evidence (p > 0.05), that the group exposed to the use of the dermal matrix produced in a tissue bank presents better scar healing parameters compared to the control group, considering the results of the Vancouver Scar Scale as the main outcome variable. This was evidenced in all follow-up assessments up to month 6.

Conclusions

Further study in dermal matrices is warranted due to the wide range of expensive options available. Results align with previous literature, favoring the use of such tissue based on objective variables and expert evaluation, despite potential bias. The use of this type of matrix shows encouraging results in improving scar healing in burn patients, without increasing graft intake time or complications. This represents the first comparative study in Latin America, demonstrating a matrix of lower cost compared to those available in the market.

Level of evidence

Level III, Therapeutic.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (France)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The authors of the present prospective cohort study, which includes patients with burns, Declare that while the data collected in this study is not stored in a public repository, the authors guarantee the secure archiving and diligent care of all data obtained during the research. The data is stored in secure digital storage accounts, protected by robust security measures, ensuring the integrity and confidentiality of the data.

Although the data is not publicly accessible in a repository, interested parties may contact the corresponding author for inquiries regarding data access and potential collaboration, subject to ethical and legal considerations.

The authors affirm their commitment to transparency and scientific integrity in handling and safeguarding the data obtained from the study.

References

  1. Skowronek K, Łabuś W, Stojko R, Kitala D, Sadłocha M, Drosdzol-Cop A (2022) Application of Acellular dermal matrix in Gynaecology—A Current Review. J Clin Med 11(14):1–9

    Article  Google Scholar 

  2. Corrêa FB, Castro JCD, Almeida IR, Farina-Junior JA, Coltro PS (2022) Evaluation of contraction of the split-thickness skin graft using three dermal matrices in the treatment of burn contractures: a randomised clinical trial. Wound Repair Regen 30(2):222–231

    Article  PubMed  Google Scholar 

  3. Guerrero Serrano L (2020) Vigencia De Los bancos de tejidos laminares. Cirugía Plástica Ibero Latinoam 46(Supl1):s23–30

    Google Scholar 

  4. Albanna MZ, Holmes JH (2016) Skin tissue Engineering and Regenerative Medicine. Skin Tissue Eng Regenerative Med. 1–443 p

  5. Pirayesh A, Hoeksema H, Richters C, Verbelen J, Monstrey S (2015) Glyaderm® dermal substitute: Clinical application and long-term results in 55 patients. Burns [Internet]. 41(1):132–44. https://doi.org/10.1016/j.burns.2014.05.013

  6. Pirayesh A, De Decker I, Richters CD, Paauw NJ, Hoeksema H, Hoekstra MJ et al (2022) Comparison of Glyaderm with different dermal substitute matrices in a porcine wound model. JPRAS Open [Internet]. 34:257–67. https://doi.org/10.1016/j.jpra.2022.09.005

  7. Petrie K, Cox CT, Becker BC, MacKay BJ (2022) Clinical applications of acellular dermal matrices: a review. Scars Burn Heal 8:205951312110383

    Article  Google Scholar 

  8. Brusselaers N, Pirayesh A, Hoeksema H, Richters CD, Verbelen J, Beele H et al (2010) Skin replacement in burn wounds. J Trauma - Inj Infect Crit Care 68(2):490–501

    Google Scholar 

  9. Richters CD, Pirayesh A, Hoeksema H, Kamperdijk EWA, Kreis RW, Dutrieux RP et al (2008) Development of a dermal matrix from glycerol preserved allogeneic skin. Cell Tissue Bank 9(4):309–315

    Article  CAS  PubMed  Google Scholar 

  10. Gaviria JL, Gómez-Ortega V (2018) One-stage reconstruction of neck burns with single-layer dermal matrix. Plast Aesthetic Res 5(9):35

    Article  Google Scholar 

  11. Rosero JC (2018) Tratamiento De secuelas de quemadura en miembro superior con la utilización de matriz dérmica acelular. 24(2):9–13

  12. Khoo TL, Halim AS, Saad AZM, Dorai AA (2010) The application of glycerol-preserved skin allograft in the treatment of burn injuries: an analysis based on indications. Burns 36(6):897–904

    Article  CAS  PubMed  Google Scholar 

  13. Munster AM, Smith-Meek M, Shalom A (2001) Acellular allograft dermal matrix: Immediate or delayed epidermal coverage? Burns 27(2):150–153

    Article  CAS  PubMed  Google Scholar 

  14. Verbelen J, Hoeksema H, Pirayesh A, Van Landuyt K, Monstrey S (2016) Exposed tibial bone after burns: Flap reconstruction versus dermal substitute. Burns [Internet]. 42(2):e31–7. https://doi.org/10.1016/j.burns.2015.08.013

  15. Avila Leon JL, Rivero CR, Guerrero L, Alviar JD, Rodríguez MA, Arocha AM et al (2023) Immediate results of the use of split-thickness skin autografts with and without acellular dermal matrix in patients with burns, a comparative study in a Colombian population. J Burn Care Res. 1–8

  16. Panayi AC, Orgill DP (2019) Current use of biological scaffolds in plastic surgery. Plast Reconstr Surg 143(1):209E–220E

    Article  Google Scholar 

  17. Nguyen DQA, Potokar TS, Price P (2010) An objective long-term evaluation of Integra (a dermal skin substitute) and split thickness skin grafts, in acute burns and reconstructive surgery. Burns 36(1):23–28

    Article  PubMed  Google Scholar 

  18. Jackson SR, Roman S (2019) Matriderm and split skin grafting for full-thickness pediatric facial burns. J Burn Care Res 40(2):251–254

    Article  PubMed  Google Scholar 

  19. Leclère FM, Desnouveaux E, Choughri H, Casoli V (2018) Acellular dermal matrix: New applications for free flap pedicle coverage–A prospective study in 10 patients. J Cosmet Laser Ther 20(4):200–204

    Article  PubMed  Google Scholar 

  20. Campbell KT, Burns NK, Ensor J, Butler CE (2012) Metrics of cellular and vascular infiltration of human acellular dermal matrix in ventral hernia repairs. Plast Reconstr Surg 129(4):888–896

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Manrique OJ, Huang TCT, Martinez-Jorge J, Ciudad P, Forte AJ, Bustos SS et al (2020) Prepectoral two-stage implant-based breast reconstruction with and without acellular dermal matrix: do we see a difference? Plast Reconstr Surg. ;263E–272E

  22. Carlsson AH, Gronet EM, Rose LF, Chan R (2016) Clinical Applications of Acellular Dermal Matrices in Reconstructive Surgery [Internet]. Skin Tissue Engineering and Regenerative Medicine. Elsevier Inc.; 109–124 p. https://doi.org/10.1016/B978-0-12-801654-1.00006-1

  23. Sanz del Pozo M, Sanz Aranda E, Monclús Fuertes E, Gil Sanz MJ, Agulló Domingo A (2022) The use of Matriderm for penile reconstruction: a case series. Eur J Plast Surg [Internet]. 45(3):451–62. https://doi.org/10.1007/s00238-021-01894-2

  24. Ferrando PM, Balmativola D, Cambieri I, Scalzo MS, Bergallo M, Annaratone L et al (2016) Glycerolized reticular dermis as a new human acellular dermal matrix: an exploratory study. PLoS ONE 11(2):1–17

    Article  Google Scholar 

  25. Shahrokhi S, Arno A, Jeschke MG (2014) The use of dermal substitutes in burn surgery: Acute phase. Wound Repair Regen 22(1):14–22

    Article  PubMed  Google Scholar 

  26. Bloemen MCT, Van Der Wal MBA, Verhaegen PDHM, Nieuwenhuis MK, Van Baar ME, Van Zuijlen PPM et al (2012) Clinical effectiveness of dermal substitution in burns by topical negative pressure: a multicenter randomized controlled trial. Wound Repair Regen 20(6):797–805

    Article  PubMed  Google Scholar 

  27. Terzini M, Aldieri A, Zanetti EM, Massai D, Audenino AL, Bignardi C (2018) Native human dermis versus human acellular dermal matrix: a comparison of biaxial mechanical properties. Australas Med J 11(8):434–442

    Article  Google Scholar 

  28. Heimbach DM, Warden GD, Luterman A, Jordan MH, Ozobia N, Ryan CM et al (2003) Multicenter postapproval clinical trial of Integra® dermal regeneration template for burn treatment. J Burn Care Rehabil 24(1):42–48

    Article  PubMed  Google Scholar 

  29. Li X, Meng X, Wang X, Li Y, Li W, Lv X et al (2015) Human acellular dermal matrix allograft: A randomized, controlled human trial for the long-term evaluation of patients with extensive burns. Burns [Internet]. 41(4):689–99. https://doi.org/10.1016/j.burns.2014.12.007

  30. Almeida IR, Gonqalves AC, Corrêa FB, Castro JCD, Guirro ECO, Farina JA et al (2023) Evaluation of clinical and biomechanical features of scars resulting from the treatment of burn contractures comparing Acellular dermal matrices: a Randomized Clinical Trial. Ann Surg 277(2):198–205

    Article  PubMed  Google Scholar 

  31. Bloemen MCT, Van Leeuwen MCE, Van Vucht NE, Van Zuijlen PPM, Middelkoop E (2010) Dermal substitution in acute burns and reconstructive surgery: a 12-year follow-up. Plast Reconstr Surg 125(5):1450–1459

    Article  CAS  PubMed  Google Scholar 

  32. Pan Y, Liang Z, Yuan S, Xu J, Wang J, Chen S (2011) A long-term follow-up study of acellular dermal matrix with thin autograft in burns patients. Ann Plast Surg 67(4):346–351

    Article  CAS  PubMed  Google Scholar 

  33. Hicks KE, Huynh MN, Jeschke M, Malic C (2019) Dermal regenerative matrix use in burn patients: a systematic review. J Plast Reconstr Aesthetic Surg 72(11):1741–1751

    Article  Google Scholar 

  34. Monclús Fuertes E, Perales Enguita A, Sanz Aranda E, Reola Ramírez E, Agulló Domingo A (2020) Utilización de matrices dérmicas en quemaduras TT - Use of dermal matrices in burns. Cirugía Plástica Ibero-Latinoamericana [Internet]. 46:39–46. http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0376-78922020000200039&lang=en%0Ahttp://scielo.isciii.es/pdf/cpil/v46s1/1989-2055-cpil-46-s1-0039.pdf

Download references

Author information

Authors and Affiliations

  1. District Institute of Science, Biotechnology, Industrial University of Santander, Bucaramanga, Colombia

    Jorge Luis Ávila León & Linda Guerrero Serrano

  2. Health Innovation (IDCBIS), Hospital Universitario de Santander, 150 Street #45-62, Bucaramanga,, Colombia

    Jorge Luis Ávila León & Linda Guerrero Serrano

  3. Aesthetic and Reconstructive Plastic Surgeon, Postgraduate Professor at Industrial University of Santander, Bucaramanga, Colombia

    Carlos Ramírez Rivero & Jorge Andrés Rueda Gutierrez

  4. Medical doctor from Sabana University, 150 Street #45-62, Bogota, Colombia

    Diego Villarreal Sepulveda & Juan Esteban Ospina Gomez

  5. Medical doctor from Sabana University, Cundinamarca, Colombia

    Andrea Caro Becerra

Authors
  1. Jorge Luis Ávila León
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carlos Ramírez Rivero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Linda Guerrero Serrano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jorge Andrés Rueda Gutierrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Diego Villarreal Sepulveda
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Andrea Caro Becerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Juan Esteban Ospina Gomez
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Jorge Luis Ávila León, Contributed to, Project direction, Planning, research project development, data collection, data analysis, Writing, and article editing; Carlos Ramírez Rivero, Linda Guerrero Serrano and Jorge Andrés Rueda Gutierrez Contributed to, Planning, research project development, data analysis. Article editing; Diego Villarreal Sepulveda, Andrea Caro Becerra and Juan Esteban Ospina Gomez Contributed to, Planning, research project development, Article editing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jorge Luis Ávila León.

Ethics declarations

Ethical approval

The study was approved by the ethics committees of three involved institutions, Committee of tissue bank belonging to the District Institute of Science, Biotechnology, and Health Innovation (IDCBIS) (approval Number: IDCBIS-GC-FT-008), scientific research ethics committee of Industrial university of Santander (CEINCI) (approval Number: 4110) and the ethic committee of Hospital Universitario de Santander where the burns united was located in the city of Bucaramanga, Colombia (approval Number: 900-SSAC-096-2021). It was conducted in compliance with ethical principles, adhering to Colombian laws, and considering internationally established standards including the Declaration of Helsinki and the principles of the Belmont Report, which emphasize respect for individuals. Informed consent was obtained from all participants, and confidentiality of patient information was maintained, ensuring beneficence and justice. Likewise, current regulations governing the handling of personal data were adhered to.

Financial statements

All authors have disclosed and disclaim any financial or personal relationships that could potentially bias their work or influence the interpretation of the research results presented in this manuscript.

It was an interinstitutional study between the District Institute of Science, Biotechnology, and Health Innovation (IDCBIS) and Industrial University of Santander, for that reason the glycerolized acellular dermal matrix necessary for the study was provided for tissue bank.

Informed consent

Informed consent to participate and publish was obtained from all individual participants included in the study and a written informed consent was obtained from the parents. The authors affirm that human research participants provided informed consent for publication of the images in Figs. 2, 3 and 4.

Competing interests

The authors declare that they have no conflicts of interest regarding the publication of this study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ávila León, J.L., Rivero, C.R., Serrano, L.G. et al. Evaluation of the use of an acellular dermal matrix produced in a tissue bank with and without skin autografts in burn patients: a comparative study in a Colombian population. Eur J Plast Surg 47, 52 (2024). https://doi.org/10.1007/s00238-024-02192-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00238-024-02192-3

Keywords

Search

Navigation