Immunohistochemical Analysis of Postburn Scars following Treatment Using Dermal Substitutes

Abstract

Background. Post-burn hypertrophic scars commonly occur after burns. Studies that compare dermal substitutes with other treatment methods are insufficient. The purpose was to analyze the histopathological differences in hypertrophic burn scars after Matriderm®+split-thickness skin graft (STSG) and compare with AlloDerm®+STSG, STSG, full-thickness skin graft (FTSG), and normal skin. Methods. Samples of unburned, normal skin and deep 2nd or 3rd degree burns were obtained from patients who experienced a burn injury in the past to at least 6 months before biopsy, which was performed between 2011 and 2012. All subjects received >6 months of treatment before the biopsy. Intervention groups were normal (63), STSG (28), FTSG (6), Matriderm® (11), and AlloDerm® (18). Immunohistochemical analyses of elastin, collagen I, collagen III, cluster of differentiation 31 (CD31), smooth muscle actin (α-SMA), and laminin from scar and control tissues were performed and compared. Results. α-SMA vascular quantity and vessel width, stromal CD31, and basement membrane laminin expression were not significantly different between normal and intervention groups. Matriderm® group showed no significant difference in elastin, collagen III, stromal CD31 and α-SMA, CD31 vessel width, stromal α-SMA, vessel quantity and width, and laminin length compared to the normal group, meaning they were not significantly different from the normal skin traits. Conclusion. Dermal substitutes may be an optimal alternative to address the cosmetic and functional limitations posed by other treatment methods.

A Histological and Clinical Study of MatriDerm® Use in Burn Reconstruction

“…Elastin contents in MatriDerm® samples were almost half those of normal skin or FTG but more than SSG or Alloderm®. 37 These results and the histological findings in our current study, question the effectiveness of the elastic fibers in the MatriDerm® matrix.…”

Application of dermal substitutes in the surgical treatment of full‐thickness wounds: Outcomes of an international survey

“…The National Burn Care, Education & Research group, The Netherlands consist of: M. E. van Baar 1,2 , L. van Dammen 1,3,4 , S. J. G. Geelen 3,5,6 , T. M. Haanstra 7-9 , D. N. Hulleman 3,5,6 , R. van Gemert 10 , C. A. Lansdorp 11 , A. Meij-de Vries 12,13 , M. K. Nieuwenhuis 5,6,14 , R. F. C. Salemans 15,16 , C. M. H. van Schie 7 , S. M. H. J. Scholten-Jaegers 3 , I. Spronk 1,7-9 , R. S. M. Thambithurai 15,17…”

“…Several trials have proven the effectiveness of dermal substitutes in surgical wound treatment. 3 , 4 , 5 , 6 Our recent investigation of the literature showed that a total of 25 trials have been conducted comparing the treatment outcomes of dermal substitutes with standard‐of‐care approaches (e.g., autologous split‐thickness skin) or comparing different types of dermal substitutes in patients with partial‐ and full‐thickness burns or reconstructive wounds after burns. 1 , 3 , 4 , 5 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 Dermal substitutes are mainly used in acute and reconstructive burn surgery, particularly for treating deep burns.…”

“… 3 , 4 , 5 , 6 Our recent investigation of the literature showed that a total of 25 trials have been conducted comparing the treatment outcomes of dermal substitutes with standard‐of‐care approaches (e.g., autologous split‐thickness skin) or comparing different types of dermal substitutes in patients with partial‐ and full‐thickness burns or reconstructive wounds after burns. 1 , 3 , 4 , 5 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 Dermal substitutes are mainly used in acute and reconstructive burn surgery, particularly for treating deep burns. Additionally, they find application in addressing full‐thickness skin defects arising from various sources, including traumatic injuries, post‐melanoma surgical resections and breast reconstruction procedures.…”

“…Despite favourable trial results, dermal substitutes have not yet been adopted as a standard of care. 5 , 32 , 33 Professionals may encounter barriers that hinder the implementation of dermal substitutes in their daily practice. It is crucial to address these barriers to improve implementation and achieve better outcomes.…”