Successful engraftment of skin grafts highly depends on the quality of the wound bed. Good quality of blood vessels near the surface is critical to support the viability of the graft. Ischemic, irradiated scar tissue, bone and tendons will not have the sufficient blood supply. In such situations flaps are to be resorted. However, the flaps also need to have good vascularity over the limbs. The introduction of dermal substitutes has provided a novel method for repairing various severe skin defects. These substitutes act as dermal regenerative templates, which facilitate dermal reconstruction and regeneration. This study was done to ascertain the effectiveness of these substitutes in the treatment of complex wounds. Between January 2022 and June 2023, 20 patients who had complex wounds, which could not be treated with simple skin grafting and who were treated with collagen and elastin matrix and split skin grafting (SSG) were retrospectively studied. The percentage of SSG take as per the records was noted at a 10-day post-operative period. Patient characteristics, comorbidities, duration and outcomes of the treatment were noted. Twenty patients were included in the study. The minimum size of the ulcer was 5 × 4 cm (area of 20 cm2) and the maximum size of the ulcer was 15 × 15 cm (225 cm2). Average take of skin graft was 93.7% at 10th post-operative day. Recurrence at 6 months was nil. The scar quality was assessed by patient and observer at 3 months and 6 months post-operatively. The lower-limb ulcers with compromised surrounding tissue are complex. The major goal in these cases is to do simple surgery and prevent recurrence. The collagen and elastin matrices provide structural support for cellular infiltration, which helps maximize a SSG take and a stable long-term scar.

Department of Plastic and Reconstructive Surgery Ramaiah Medical College Bangalore India

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