Creating a three-dimensional human skin burn model using commercially available synthetic dermal replacement matrices

Miss Olivia McGifford1, Miss Hollie Ryan2, Mrs Elizabeth Chessman1, Associate Professor Tim, R. Dargaville2, Doctor Leila Cuttle1

1Centre for Children’s Burns and Trauma Research, Queensland University of Technology, Institute of Health and Biomedical Innovation at Centre for Children’s Health Research, South Brisbane, Australia, 2School of Chemistry, Physics and Mechanical Engineering, Science and Engineering Faculty, Queensland University of Technology, Brisbane City, Australia

Abstract:

In Australia, approximately 2,000 children/year are hospitalized due to burn injuries and the after-effects can last a lifetime. New burn wound therapies are tested on animal models, however this is expensive and ethically questionable. A 3D, composite, in vitro skin model would enable rapid testing of new potential treatments. Dermal replacement matrices (DRM) are used surgically to replace skin in deep burn injuries. They are readily available and could be utilised as a human “in vitro” skin model. In this study, human primary keratinocyte and fibroblast skin cells were grown on four matrices (Biobrane®, Biodegradable-Temporising Matrix – BTM, Integra® and Matriderm®) to grow tissue similar to native human skin. Different ratios of the primary cells were seeded onto the matrices to determine the cell numbers required for optimal growth. Fluorescent staining confirmed the presence of living and dead cells within the matrices. Histological dyes were used to observe morphology and immunohistochemistry was used to characterize and localize the cells. After the model was confirmed to be similar to native human skin, it was used as an “in vitro human skin” burn model and the staining techniques described above were used to characterise the cell damage. Integra® and Matriderm® had the most suitable cell adherence and proliferation. Biobrane®, BTM and Matriderm® withstood heat up to 90° without deformation. The most appropriate DRM for an in vitro skin burn model was Matriderm®, as it supported superior cell growth and withstood the heat of burning.


Biography:

Studied Biomedical Science, majoring in anatomy and minoring in human physiology and cell and molecular bioinfomatics. Graduated last year with distinction

Initial clinical experience using Matriderm to treat a paediatric full thickness facial burn: a nursing perspective

Deborah A E Maze1, Gisela A Olson2

1The Burns Unit & the Children’s Hospital at Westmead Burns Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW 2145 deborah.maze@health.nsw.gov.au

2The Burns Unit & the Children’s Hospital at Westmead Burns Research Institute, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW 2145 gisela.olson@health.nsw.gov.au

Abstract

The management of full thickness facial burns can be challenging and complex. In 2017, our Burns Unit treated a 2 year old female who sustained a 60% TBSA full thickness flame burn injury involving the entire face.

Successful regeneration of dermal tissue is important in the restoration of normal functionality and aesthetic appearance. Advancements in the development of skin substitutes aim to provide improved elasticity, flexibility, stability and strength of the reconstructed skin whilst reducing wound contraction and improving scar appearance.

Surgical management of full thickness facial burns in our institution has previously involved early tangential excision (+/- temporary application of cadaveric skin) and split thickness sheet grafting.

This case study will demonstrate the use of Matriderm, a collagen-elastin matrix dermal substitute, applied in a one-stage surgical procedure in combination with a split thickness skin graft to reconstruct the full thickness facial burn wound, a first for the treatment of a paediatric full thickness facial burn in Australia.

Discussion will include initial wound management, the application process for Matriderm, challenges around wound management post skin grafting and complications experienced. An early scar management regime was initiated and included use of a transparent face orthosis and custom made compression garment. Initial skin graft results will be included along with the child’s outcome at 10 months post burn injury.

Matriderm has proven to be a successful dermal substitute in this case. Ongoing follow up will be required to determine the long term outcome of skin quality, pliability and scar appearance.

References

  1. Atherton D, Tang R, Jones I, Jawad M. Early excision and application of Matriderm with simultaneous autologous skin grafting in facial burns. Plastic & Reconstructive Surgery, 2010
  2. Demircan M, Cicek T, Yetis M. Preliminary results in single step wound closure procedure of full thickness facial burns in children by using the collagen-elastin matrix and review of paediatric facial burns. Burns, 2015
  3. Min J, Yun I, Lew D, Roh T, Lee W. The use of Matriderm and autologous skin graft in the treatment of full thickness skin defects. Archives of Plastic Surgery, 2014
  4. Haslik W, Kamolz L, Nathschlager G, Andel H, Meissl G, Frey M. First experiences with the collagen elastin matrix Matriderm as a dermal substitute in severe burn injuries of the hand. Burns 2006
  5. Shevchenko R, James S, James E. A review of tissue-engineered skin bioconstructs available for skin reconstruction. Journal of The Royal Society Interface 2009
  6. Suwelack A, MedSkin Solutions, Matriderm product information 2014

 

Early therapy experience with NovoSorb™ BTM

Mr Brad Schmitt1, Mrs Kathryn  Heath2, Mrs Rochelle Kurmis3, Ms  Tanja  Klotz4, Mr Marcus Wagstaff5, Professor John Greenwood6

1Senior Physiotherapist, Adult Burns Service, Royal Adelaide Hospital, Port Road, Adelaide, Australia, 2Allied Health Project Manager, Adult Burns Service, Royal Adelaide Hospital, Port Road, Adelaide, Australia, 3Allied Health Project Manager, Adult Burns Service, Royal Adelaide Hospital, Port Road, Adelaide, Australia, 4Senior Occupational Therapist, Adult Burns Service, Royal Adelaide Hospital, Port Road, Adelaide, Australia, 5Consultant Plastic and Reconstructive Surgeon, Adult Burns Service, Royal Adelaide Hospital, Port Road, Adelaide, Australia, 6Director, Adult Burns Service, Royal Adelaide Hospital, Port Road, Adelaide, Australia

Abstract:

Background: Since 2014, NovoSorb™ BTM has been used at the Royal Adelaide Hospital to treat specific deep burn wounds.¹ Currently patients are treated in line with standard therapy protocols. As a new dermal substitute for the treatment of burn injury, the implication for the use of this product on anticipated rehabilitation times, therapy pathways and scar management compared to previous standard treatment is unknown.

Aim: To map the pattern of recovery following BTM application compared to a historic matched burn cohort.

Methods: Patients who have received BTM as part of their surgical burn wound management were identified from existing department records. Matched, retrospective cohort patients were identified based on burn size, depth, age and gender from the BRANZ database. No exclusion criteria were applied. BTM site, time post BTM application to commence range of motion (ROM), mobilisation, maximal ROM, scar management requirements and duration, scar outcome, incidence of reconstructive surgery, and length of ICU and hospital stay were collected.

Results:Twenty patients (15 male, 5 female; age 17-94 years) admitted with burn injuries ranging from 5-75 % TBSA and treated with BTM were included in this this review. Average length of stay = 82.2days (range 1.2-258.2 days). To date, nine patients have completed 12 month follow-up POSAS and MAPS assessments.

Conclusion:The use of BTM following deep burn injury comparatively decreases the amount of scar management, rehabilitation and reconstructive surgery required. The pattern of recovery following BTM and subsequent care pathway recommendations will be presented.

References:
1.Greenwood JE, Schmitt BJ and Wagstaff MJD. Experience with a synthetic bilayer Biodegradable Temporising Matrix in significant burn injury. Burns Open. DOI: 10.1016/j.burnso.2017.08.001


Biography:

Brad is the Senior Physiotherapist with the Royal Adelaide Hospital Burns Unit.

A case series of Matriderm use in Australasia.

Dr Tess Brian1, Dr Nicholas Solanki1, Dr Richard Wong She1

1The National Burns Centre, Middlemore Hospital, Otahuhu, New Zealand

Abstract:

Matriderm is a dermal regeneration template composed of bovine dermal collagen and nuchal ligament elastin fibres. It allows single-stage reconstruction of a wide range of full thickness skin defects providing faster healing and return to function compared to other dermal matrices which typically require two-stage procedures. The Plastic and Reconstructive Surgery Department at Middlemore Hospital, Auckland, has used Matriderm in 11 patients from June 2016 to May 2018 for a wide variety of indications including defects from acute and reconstructive burn surgery and cancer excision. Complete graft take was achieved in 70% of cases. We will report on the success rate, complications and initial outcomes achieved so far. More importantly, advice on techniques to maximise success and ease of introduction into practice will also be discussed.

Experience to date has shown that Matriderm provides a simple, reliable single-stage procedure with satisfactory aesthetic and functional outcomes and is a useful additional tool for soft tissue reconstruction.


Biography:

Tess Brian is a Plastic and Reconstructive Surgery Registrar who has worked at Waikato and Middlemore Hospital.

A New Reconstructive Tool using a novel Biodegradable Polyurethane Dermal Substitute: the Waikato Experience

Dr Tess Brian1Dr Paul T. Cheng1, Dr  Deirdre M. Seoighe1

1Waikato Hospital, Waikato DHB, Hamilton, New Zealand

Abstract:

Introduction:A polyurethane material (NovoSorbTM Biodegradable Temporising Matrix or “BTM”; PolyNovo Biomaterials Pty Ltd, Port Melbourne, Victoria, Australia) has been derived and evaluated over the last decade, with various publications documenting its use in reconstruction. There is no local experience published, with the use of this novel product within New Zealand, to date. We hereby present our first-hand experience with the use of this material on the patients within our region.

Method:The BTM was employed in a series of complex wound scenarios in our unit, including large hand and foot defects following debridement for necrotising infection with exposed bone/tendons and/or underlying osteomyelitis. We followed the published protocols for BTM application and dressing changes. A total of 8 cases had been performed to date.

Results:Application, integration, delamination, and secondary coverage with split-skin grafting proceeded without complication. Photographic records were taken at every intervention. The average time frame between application and skin grafting is 40 days. The results to date demonstrated robust reconstruction of defects that otherwise would require more complex surgeries.

Conclusion:Our local experience enabled us to incorporate this novel product into our clinical practice on various complex wounds that previously would not be considered suitable to use synthetic dermal substitute. Longer-term follow-up is required and would be the basis of future studies.

Disclosures: The authors have no financial interests to disclose. This presentation has not been presented / published previously.


Biography:

Tess Brian is a Plastic and Reconstructive Surgery Registrar who has worked at Waikato and Middlemore Hospital.

Use of new, Synthetic Dermal Matrix in reconstruction of complex wounds resulting from necrotizing soft tissue infection, electrical and thermal burns

Dr Hamed Amani1, Dr Sigrid Blome-Eberwein1, Dr Daniel Lozano1

1Lehigh Valley Regional Burn Center, Allentown, United States

Introduction:Reconstruction of complex wounds continues to be challenging and has traditionally relied on either tissue rearrangement or use of dermal matrices to restore the affected area. Where indicated, Integra® has been the go-to dermal substitute. We present a case series of complex wounds treated successfully with a new, polyurethane-based dermal matrix (NovoSorb® BTM; PolyNovo Biomaterials Pty Ltd).

Methods:NovoSorb BTM was used to help reconstruct full-thickness skin defects with application of split-thickness skin graft (STSG). In three cases, successful reconstruction over exposed bone and tendon was achieved.

Results:Defects created by electrical injury, thermal burn and necrotizing fasciitis were treated. In each case, the matrix adhered well, even when infection was suspected. In one case, multiple layers of NovoSorb BTM was used to fill in a defect on the face with great result. Reconstruction over exposed bone was also successful.

Discussion:Massive thermal, electrical and necrotizing infections result in devastating wounds, which may be difficult to reconstruct. Reconstruction choices are often limited to STSGs, flap closure, use of dermal matrix in conjunction with STSGs, or a combination. The advantage of NovoSorb BTM is its resistance to infection, unlike collagen-based dermal matrices. In our series, we have demonstrated the ability of NovoSorb BTM to bridge soft-tissue defects over tendon and bone previously only possible with the use of biologic dermal matrices.

Conclusion:This series is the first description of NovoSorb BTM used to reconstruct exposed bone and fill deep contour irregularities with use of multiple layers.


Biography:

Dr. Hamed Amani is the Associate Medical Director of Lehigh Valley Regional Burn Center and an Assistant Professor of Surgery at the University of South Florida. The burn center is one of the busiest in America with over 1000 acute burn admissions per year. Dr. Amani has a BS in Chemistry and a BA in Philosophy. He is qualified in General Surgery, Trauma/Critical Care and Burn Surgery. He has published and regularly lectures on topics of burn surgery and burn disaster management.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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