A combined literature review and retrospective study has confirmed that the use of a dermal regenerative template (DRT) is “a viable option for providing vascularised coverage over wounds with avascular components”. Moreover, it was also found by Ronald N Bogdasarian (Rutgers New Jersey Medical School, Newark, USA) and colleagues that DRT is less successful in chronic wounds.
Published in Wounds, Bogdasarian et al’s investigation was conducted on the premise that partially avascular wounds pose a significant challenge to wound care surgeons, as they “lack blood flow and the potential to heal without intervention”. Commenting further on this prevalent issue, the authors write: “Partially avascular wounds are challenging due to the multitude of options for closure, including prolonged wound care, flaps, and dermal regenerative templates (DRTs).”
According to the authors, benefits of DRT include predictable levels of success and “minimal donor site morbidity”, although the method is limited by the higher cost and multiple surgical procedures it entails. At Rutgers New Jersey Medical School, the Integra Dermal Regenerative Template (Integra LifeSciences) is “used to augment reconstruction, enhance durability of skin grafts, and preserve function of the underlying structures.”
The main aim of this investigation into DRT was to determine the success and viability of its use in wounds with avascular components, followed by the secondary purpose of quantifying DRT’s ability to survive while covering partially avascular wounds.
In order to examine outcomes with the technique, a review of the literature was performed using Ovid MEDLINE, Google Scholar, and Cochrane Library: Bogdasarian et al explain that as part of this study, patient demographics, comorbidities, wound types, surface area of avascular tissues, and skin graft take were analysed. In addition to this, a retrospective review of institutional cases, at Rutgers New Jersey Medical School, was conducted.
Regarding the literature review, it was decided that 32 articles met the investigators’ criteria, which included “studies analysing the use of DRT to reconstruct partially avascular wounds in humans” and excluded “studies evaluating the use of DRT on wounds without avascular components, animal studies, and the use of other extracellular matrix technologies”.
“The literature demonstrated positive outcomes for the use of DRT in partially avascular wounds in several anatomic locations and wounds of diverse aetiology,” state the authors, who go on to reveal that “several techniques for wound preparation, DRT application, dressings, and time to skin graft were described, all with good results (71–100% split-thickness skin graft (STSG) take; mean, 90%).”
Twenty-six patients were included in the retrospective review, all of whom had partially avascular wounds reconstructed with DRT. On the results of this study, Bogdasarian et al write: “Seventeen patients experienced 100% graft take, six experienced partial take, and three suffered complete loss. The percent and absolute size of avascular surface area in the wound was significantly lower in cases of complete graft take, compared with partial take and complete loss (1.9% and 2.7cm2; 9.3% and 10cm2; 18% and 9.3cm2, respectively; p<0.001).” Furthermore, it was found that chronic wound status (p<0.001) was significantly associated with less graft take.
Authors of the investigation have described this study as the first to describe, quantitatively, the ability of DRT to successfully reconstruct partially avascular wounds. They add: “While limited by its retrospective design, this study suggests this DRT is more successful in wounds with less than 1.9% to 9.3% avascular tissues and less successful in chronic wounds.
“This systematic literature review and retrospective chart review demonstrate DRT is a viable option for reconstruction of partially avascular wounds,” the authors conclude, while “the results support the feasibility and safety of a future prospective study to quantify the ability of this DRT to survive over avascular tissues. Such a study may generate specific, standardised guidelines.”
