Xenogenous dermal matrices are used for hernia repair and breast reconstruction. Full-thickness skin replacement is needed after burn or degloving injuries with exposure of tendons or bones. The authors used a human skin organ culture model to study whether porcine reconstructive tissue matrix (Strattice) is effective as a dermal tissue replacement.
Skin cells or split-thickness skin grafts were seeded onto human deepidermized dermis, Strattice, and Matriderm. Cellular resurfacing and matrix infiltration were monitored by live fluorescence imaging, histology, and electron microscopy. Proliferation, apoptosis, cell differentiation, and adhesion were analyzed by immunohistochemistry.
Epithelial resurfacing and vertical proliferation were reduced and delayed with both bioartificial matrices compared with deepidermized dermis; however, no differences in apoptosis, cell differentiation, or basement membrane formation were found. Vertical penetration was greatest on Matriderm, whereas no matrix infiltration was found on Strattice in the first 12 days. Uncompromised horizontal resurfacing was greatest with Strattice but was absent with Matriderm. Strattice showed no stimulatory effect on cellular inflammation.
Matrix texture and surface properties governed cellular performance on tissues. Although dense dermal compaction delayed vertical cellular ingrowth for Strattice, it allowed uncompromised horizontal resurfacing. Dense dermal compaction may slow matrix decomposition and result in prolonged biomechanical stability of the graft. Reconstructive surgeons should choose the adequate matrix substitute depending on biomechanical requirements at the recipient site. Strattice may be suitable as a dermal replacement at recipient sites with high mechanical load requirements.
Bremen, Hannover, and Essen, Germany
From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Klinikum Bremen-Mitte, Center for Biomolecular Interactions Bremen and Collaboration Center Medicine, University of Bremen; the Department of Plastic, Hand, and Reconstructive Surgery, Hannover Medical School; and the Division of Plastic and Reconstructive Surgery, Clinic for Senologie/Breast Center, Kliniken Essen-Mitte Evang. Huyssens Stiftung/Knappschaft GmbH.
Received for publication October 28, 2012; accepted April 16, 2013.
Presented at the Joint Annual Meeting of the Austrian Society of Plastic, Aesthetic, and Reconstructive Surgery, the German Society of Plastic, Reconstructive, and Aesthetic Surgeons, and the Association of German Aesthetic Plastic Surgeons, in Innsbruck, Austria, September 30 through October 2, 2011; and at the 21st Annual Meeting of the European Tissue Repair Society, in Amsterdam, The Netherlands, October 5 through 7, 2011.
Disclosure:Dr. Breuing is a consultant for LifeCell Corporation, and Ms. Kerzel has received travel grants from LifeCell Corporation. The other authors have no financial interest to declare in relation to the content of this article.
Ursula Mirastschijski, M.D., Ph.D., Department of Plastic, Reconstructive and Aesthetic Surgery, Klinikum Bremen-Mitte gGmbH, University of Göttingen, St.-Jürgen-Str. 1, D-28177 Bremen, Germany, firstname.lastname@example.org