ABSTRACT
Background: Dermal substitutes are currently largely used for the treatment of huge skin loss
in patients in critical general health conditions, for the treatment of severe burns
and to promote the healing process in chronic wounds. Aims: The authors performed a retrospective assessment of their experience with bioengineered
skin to possibly identify the most appropriate clinical indication and management
for each substitute. Materials and Methods: The study involved 109 patients with 127 skin defects repaired with dermal substitutes
over a 9 years period, from 2007 to 2016. Hyalomatrix® was used in 63 defects, whereas Integra® and Nevelia® were used in 56 and 8 defects, respectively. Results: The statistical analysis failed to reveal a correlation between the choice of a specific
dermal substitute and any possible clinical variable except in the soft-tissue defects
of the scalp where Hyalomatrix® was electively used. Conclusions: In the authors’ experience, the scalp defects followed a radical excision of skin
tumours that included the periosteum. Here, the preliminary cover with a hyaluronan
three-dimensional scaffold constantly allowed for the regeneration of a derma-like
layer with a rich vascular network fit for supporting a split-thickness skin graft.
Nevertheless, the authors still prefer Integra® when the goal is a better cosmetic outcome and Hyalomatrix® when a faster wound healing is required, especially in the management of deep wounds
where the priority is a fast obliteration with a newly formed tissue with a rich blood
supply. However, these clinical indications still are anecdotally based.
KEY WORDS
Clinical application - collagen - dermal substitutes - hyaluronan - skin reconstruction
