Matrix Channels Improve Autograft Take In A Single Stage Procedure
Angana Kharge, PhD, Ankur Gandhi, PhD, Sunil Saini, PhD.
INTEGRA LIFESCIENCES, Plainsboro, NJ, USA.
Background: Soft tissue defects treated with dermal substitutes often require a two-stage procedure to achieve epidermal closure. The purpose of the first stage is to achieve an appropriate dermal bed which can support a thin autologous split thickness skin graft (STSG) applied in a second stage, typically 2-3 weeks after the initial stage. A single-stage procedure, in contrast, will save the patient a second operative procedure, minimize hospital stay and thereby reduce overall cost of care. However, single-stage procedures could result in graft loss due to lack of contact between the graft and wound bed leading to insufficient nutrient support, and therefore additional procedures are required to achieve epidermal closure. We hypothesize that creation of micro channels in the dermal substitute may facilitate rapid cellular migration and formation of well vascularized granulation tissue to support graft viability. Methods: We investigate the effect of introducing channels into a collagen-chondroitin-6-sulfate (C6S) matrix on STSG take and compare findings to a collagen—C6S matrix without channels. In a pilot study, 4x4cm full-thickness wounds were created on the dorsum of a Yorkshire pig. A pattern of channels was mapped with a 2mm biopsy punch. STSG was applied to the wounds directly over the matrix with and without channels. Dressing changes were performed at 3 to 4 day intervals up to sacrifice at Day 14. Results: In non-fenestrated group, the autograft became necrotic and sloughed by Day 11. In contrast, the autograft was well integrated in the channel group. At 14 days, histology showed that granulation tissue formed within the channels to provide sufficient blood supply and nutrients to the overlying STSG, thereby enhancing graft survival. Conclusion: In this pilot single stage study, channels in the collagen--chondroitin-6-sulfate matrix based matrix increased autograft take. This feature is expected to prevent the added morbidity associated with prolonged multi-staged reconstructions.
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