SLR - February 2020 - Matt J. Cikra
Reference: Hicks KE, Huynh MN, Jeschke M, Malic C. Dermal Regenerative Matrix Use in Burn Patients: A Systematic Review. J Plast Reconstr Aesthet Surg. 2019 Nov;72(11)Scientific Literature Review
Reviewed By: Matt J. Cikra, DPM
Residency Program: West Penn Hospital – Pittsburgh, PA
Podiatric Relevance: Dermal Regenerative Matrix (DRM) along with other wound care products constitute the most advanced modalities that we have at our disposal for healing neuropathic, venous and arterial wounds afflicting a great number of our patients. This article explores the value added in DRM and its role in burn surgery. Burn surgery is at the forefront of wound care and leads the scientific and medical communities by informing medical and surgical decision making with groundbreaking research and innovative therapies. This article tests the hypothesis, can dermal regenerative matrix accelerate healing, provide a biological barrier, maintain appropriate aesthetic and allow return to function?
Methods: Extensive searches of CINAHL, EMBASE, MEDLINE databases as well as The Cochrane Library were completed for dates between 1988–2017. English language full-text articles describing human subjects with full-thickness burn injuries treated with DRM were included for analysis. Studies with insufficient information to extract data, review articles or animal studies, and nonburn related indications were excluded. Two independent reviewers completed preliminary and full-text screening of all articles. After Initial screening, 203 full-text articles were reviewed and only 72 met inclusion criteria for data extraction and analysis. DRM was applied to 1084 patients, from the cumulative demographic information there were 333 adult patients ( ≥18 years) and 179 pediatric patients (< 18 years).
Results: The average DRM take for acute and reconstructive burn injuries was 86 percent and 95 percent respectively. STSG was applied over the DRM, with a 93 percent take for burn reconstruction. Cultured epidermal and keratinocyte autografts (CEA) was used alone for five patients and was combined with a STSG for one patient with high take yield. There was a wide range of reported outcomes related to function and range of motion. Average gross elasticity, elastic function, biological elasticity, and viscoelasticity among 21 studies showed no statistical differences between the DRM treated burns versus standard of care. The Vancouver Scar Scale (VSS) was used in eight studies. Majority of DRM-treated sites ( > 280) showed good or excellent texture match to autograft-treated sites, with the final skin being pliable and soft. The most frequent complication was infection with the most common cause being Staphylococcus aureus. Low incidence of complications were observed across all included studies.
Conclusion: The aim of this study was to perform a systematic review of the literature to assess the clinical efficacy and safety of DRM use in patients with full-thickness burn injury. This review demonstrated improved functional and aesthetic outcomes among the majority of patients treated for acute burn injury. Through review of this article it is apparent to me that DRM is safe to use on full- thickness burn injuries, where insufficient donor skin is available in acute and reconstructive settings. The role of DRM in foot and ankle surgery shows significant promise. Post debridement tissue loss poses a significant challenge to all podiatric surgeons and clinicians, I will consider DRM in these cases going forward.