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1 MatriDerm Dermisaufbau leicht gemacht sorbion austria

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3 Leitfaden zur Wundversorgung mittels MatriDerm beim Einzeitigen Verfahren 1. Vorbereitung des Wundbetts MatriDerm wird für Vollhautdefekte und tiefe Wunden verwendet. 2. Applikation von MatriDerm Sorgen Sie für ein sauberes und gut durchblutetes Wundbett. Das Wundbett muss frei von jodhaltigen Antiseptika sein sowie von Wirkstoffen, welche für ein enzymatisches Debridement verwendet werden. Es wird empfohlen MatriDerm trocken auf den vorbereiteten Wundgrund aufzubringen. Bei der Applikation mehrerer MatriDerm Matrizes sollten diese nicht überlappend, sondern bündig eingelegt werden. Das trocken aufgelegte MatriDerm mit einer raumtemperierten physiologischen Lösung (NaCl 0,9% oder Ringerlactat) anfeuchten. MatriDerm auf die richtige Größe zuschneiden (1-2 mm überlappend). Es sollte das Wundbett komplett abdecken und einen guten Wundrandkontakt haben. Der direkte Kontakt zwischen MatriDerm und dem Wundbett ist wichtig. Falls erforderlich, Luftblasen vorsichtig ausstreichen. 3. Applikation des Hauttransplantats 4. Verband Da die aufgebaute Neodermis in den ersten Tagen noch sehr fragil ist, sollte der erste Verbandswechsel frühestens am 5. Tag erfolgen. Beim ersten Verbandswechsel kann das i.d.r. rosige Hauttransplantat aufgrund des Einzeitigen Verfahrens möglicherweise etwas blasser sein. MatriDerm 1mm wird immer gleichzeitig zusammen mit einem dünnen Spalthauttransplantat angewendet. Vorzugsweise wird die dünne Spalthaut ungemeshed angewendet. Optional kann mittels Inzisionen die Drainage von Wundexsudat verbessert werden. Falls erforderlich gemeshed anwenden. Mit Mesh 1:1,5 wurden gute Ergebnisse erzielt. Der direkte Kontakt zwischen MatriDerm und dem Hauttransplantat ist wichtig. MatriDerm und Spalthauttransplantat nach Bedarf mit Nähten, Klammern oder Fibrinkleber fixieren. Bei Anwendung von einem Vakuumverband kann auf eine zusätzliche Fixation verzichtet werden. Empfohlener Verband: Applikation eines Wunddistanzgitters (z.b. sorbion plus) Je nach zu erwartendem Exsudat drei bis vier Schichten Kompressen oder ein Absorberprodukt (z.b. sorbion sachet S) verwenden. Straffen Verband (wichtig) unter Gewährleistung der Durchblutung der Extremität anbringen. Alternativ; Fixation mit einem Vakuumverband unter Anwendung eines Wunddistanzgitters (z.b. sorbion plus). sorbion austria schwechater straße zwölfaxing

4 MatriDerm MatriDerm ist eine Collagen-Elastin-Matrix für die dermale Regeneration. Sie liefert eine hochgradig durchlässige, native dermale Matrix, welche die Grundlage für eine organisierte Besiedelung mit Hautzellen bietet. Sie unterstützt Ihre Arbeit durch einen rascheren und zuverlässigeren Verschluss dermaler Defekte. Chirurgische Herausforderungen Wirksames und sicheres Verfahren Reduktion restriktiver Narbenbildung Funktionales ästhetisches positives Ergebnis Volle Funktionalität der Gelenke Wiederherstellung der Lebensqualität des Patienten Ergebnis wie mit einer Vollhaut jedoch mit weniger Komplikationen der Entnahmestelle Höhere take rate Reduktion des Infektionsrisikos bei der ostheosynthetischen Versorgung Frühestmöglicher, permanenter Wundverschluss In Kombination mit autologen Spalthauttransplantaten Indikationen Traumatische und rekonstuktive Wunden Tiefe dermale Defekte Zum Aufbau der Dermis bei dermatochirurgisch behandelten Wunden z.b. bei chronischem Ulzera Chirurgische Wunden nach Tumorentfernungen Vollhautwunden der Verbrennungschirurgie Verbrennungen IIb - III Wundverschluss wenn eine Primärnaht unwahrscheinlich ist Narbenkorrektur Behandlung transplantationspflichtiger, schlechtheilender Wunden Für den Dermisaufbau auch über freiliegende Sehnen und Knochen möglich. (Bridge-Effekt) Anwendung: Freiliegende Sehnen 80-jähriger Patient mit Hauttumor auf dem Handrücken. Begleiterkrankungen: Chronische Herzinsuffizienz NYHA III, Diabetes, Arrhythmia absoluta. Tag 0 Tiefe Wunde mit freiliegenden Sehnen nach Tumorresektion Tag 7 postoperativ Gute Heilungsrate 6 Monate postoperativ Exzellentes funktionales und ästhetisches Ergebnis Bestellinformation Produktname Größe in mm Packung Bestellnummer MatriDerm A8 52 x 74 x 1 1 Stk. M MatriDerm A8 52 x 74 x 1 10 Stk. M MatriDerm A6 105 x 148 x 1 1 Stk. M MatriDerm A6 105 x 148 x 1 5 Stk. M MatriDerm A6 105 x 148 x 2 5 Stk. M * MatriDerm A4 210 x 297 x 1 1 Stk. M MatriDerm A4 210 x 297 x 2 1 Stk. M * *in der Schweiz nur auf Bestellung erhältlich

5 Studie zu MatriDerm Elastin-derived peptides enhance angiogenesis by promoting endothelial cell migration and tubulogenesis through upregulation of MT1-MMP Research Article 343 Elastin-derived peptides enhance angiogenesis by promoting endothelial cell migration and tubulogenesis through upregulation of MT1-MMP Arnaud Robinet 1, *, Abdel Fahem 1, *, Jean-Hubert Cauchard 1, Eric Huet 1, Loïc Vincent 2, Sandrine Lorimier 3, Franck Antonicelli 1, Claudine Soria 2, Michel Crepin 4, William Hornebeck 1 and Georges Bellon 1, 1 Laboratoire de Biochimie et Biologie Moléculaire, CNRS UMR 6198, IFR 53 Biomolécules, Faculté de Médecine, Université de Reims Champagne-Ardenne, 51 rue Cognacq Jay, Reims CEDEX, France 2 Groupe de Recherche MERCI, EA CNRS 2122, Faculté de Médecine et de Pharmacie, 22 Boulevard Gambetta, Rouen, France 3 Laboratoire Biomatériaux, INSERM EMI, IFR 53 Biomolécules, Faculté d Odontologie, Université de Reims-Champagne-Ardenne, 1 rue du Maréchal Juin, Reims CEDEX, France 4 Laboratoire Hémostase, Endothélium et Angiogenèse, INSERM U553, Hôpital St Louis, 1 Avenue Claude Vellefaux, Paris CEDEX 10, France *These authors contributed equally to this work Author for correspondence ( Accepted 22 October 2004 Journal of Cell Science 118, Published by The Company of Biologists 2005 doi: /jcs Journal of Cell Science Summary Elastin-derived peptides display a wide range of biological activities in a number of normal and transformed cells but their involvement in angiogenesis has not been reported. In the present study, we show that κ-elastin and VGVAPG hexapeptide elastin motif accelerated angiogenesis in the chick chorio-allantoic membrane in an in vivo model. They also stimulated pseudotube formation from human vascular and microvascular endothelial cells in the matrigel and collagen models as well as cell migration in an in vitro wound healing assay. Confocal and scanning electron microscopy analyses revealed the main reorganization of actin filaments mediated by elastin-derived peptides and changes in cell shape that correlated with a decrease of the cell form factor determined by computerized image analysis. Such elastin-derived peptide effects were attributed to upregulation of promt1-mmp and prommp- 2 expression and activation at both the mrna and protein levels. Batimastat, an inhibitor of furin convertase and TIMP-2, but not TIMP-1, totally abolished the influence of elastin-derived peptides (EDPs) on cell migration and tubulogenesis, thus favoring the involvement of MT1-MMP in such processes. To assess its contribution to EDPmediated angiogenesis further, we used a small interfering RNA (sirna) approach for specifically silencing MT1- MMP in human microvascular endothelial cells. Four sets of 21 bp sirna duplexes targeting MT1-MMP mrna were synthesized by in vitro transcription. Two of them proved to inhibit MT1-MMP expression efficiently but did not affect MT2-, MT3- and MT5-MMP expression. Seventytwo hours after transfection with 25 nm sirnas EDPinduced MT1-MMP expression at the mrna and protein levels was decreased fourfold. In parallel, prommp-2 activation was inhibited. A scrambled sirna, used as a negative control, had no effect. Finally, the effect of elastin peptides on pseudotube formation in MT1-MMP-siRNA transfected cells was totally abolished. These data emphasise the crucial role of MT1-MMP in the elastininduced angiogenic phenotype of endothelial cells. Key words: Angiogenesis, Elastin, Matrix metalloproteinase, Elastin receptor, sirna Introduction of endothelial cells (Liotta et al., 1993; Hanahan and Folkman, Angiogenesis involves the formation of capillaries from preexisting microvessels 1996; Distler et al., 2002). Disruption of such an equilibrium Vollständige Studie and therefore abrufbar contributes unter: to vascular can favor the emergence of new vessel formation or lead to remodeling and maturation (Carmeliet, 2000). It plays a pivotal vessel quiescence or regression (Hanahan and Folkman, 1996). function in a variety of normal and pathological conditions Several protein families can promote angiogenesis, among such as embryonic development, the menstrual cycle, hair which are growth factors, cytokines, integrins, proteinases, cycle, wound healing, arthritis, psoriasis, proliferative diabetic extracellular matrix components and cell adhesive proteins retinopathy, atherosclerosis, post ischemic vascularization of (Folkman, 1995; Risau, 1997; Carmeliet and Jain, 2000). The the myocardium and tumor growth and metastasis (Folkman, contribution of matrix metalloproteinases (MMPs), especially 1995; Risau, 1997). The initiation of the physiopathological MMP-2, MMP-9 and membrane-type metalloproteinase-1 angiogenic response, known as the angiogenic switch, (MT1-MMP, MMP-14) has been convincingly established by depends on the dynamic balance between exogenous or the use of natural or synthetic MMP inhibitors, both in vitro endogenous stimuli (pro-angiogenic factors) and inhibitors and in vivo (Moses, 1997; Maekawa et al., 1999; Hajitou et sorbion (anti-angiogenic austria schwechater factors) acting straße in the 37 immediate 2322 zwölfaxing environment +43 al., ) Genetic +43 studies used 38 mice deficient in those

6 Studie zu MatriDerm Management of full-thickness Author's skin defects personal in the copy hand and wrist region: first long-term experiences with the dermal matrix MatriDerm Journal of Plastic, Reconstructive & Aesthetic Surgery (2010) 63, 360e364 Management of full-thickness skin defects in the hand and wrist region: first long-term experiences with the dermal matrix Matriderm * W. Haslik a, L.-P. Kamolz a, *, F. Manna b, M. Hladik a, T. Rath a, M. Frey a a Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical University of Vienna, Austria b Department of Surgery, Children s Hospital Burlo Garofolo IRCCS, Trieste, Italy Received 17 February 2008; accepted 29 September 2008 KEYWORDS Collageneelastin matrix; Dermal substitute; Full-thickness skin defect; One-stage grafting; Upper extremity Summary The gold standard for the coverage of full-thickness skin defects is autologous skin grafts. However, poor skin quality and scar contracture are well-known problems in functional, highly strained regions. The use of dermal substitutes is an appropriate way to minimise scar contraction and, thereby, to optimise the quality of the reconstructed skin. The aim of this study was to evaluate the impact of the collageneelastin matrix, Matriderm, for the single-step reconstruction of joint-associated defects of the upper extremity. Seventeen patients with full-thickness skin defects of the upper extremity were treated with the dermal substitute, Matriderm, and unmeshed skin graft in the functional critical region of the distal upper extremity in a single-step procedure. The take rate of the matrix-and-skin graft was 96%. Long-term follow-up revealed an overall Vancouver scar scale of 1.7. No limitation concerning hand function was observed; DASH-score analysis revealed excellent hand function in patients with burn injury and patients with a defect due to the harvest of a radial forearm flap achieved satisfying hand function. This matrix represents a viable alternative to other types of defect coverage and should therefore be considered in the treatment of skin injuries, especially in very delicate regions such as the joint regions. The possibility of performing a one-stage procedure is supposed to be a major advantage in comparison to a two-stage procedure. ª 2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. * Parts of the results were presented at the 13th Congress of the International Society for Burn Injuries ISBI 2006 in Brazil. * Corresponding author. Division of Plastic and Reconstructive Surgery, Department of Surgery, Medical School, University of Vienna, Austria, Waehringer Guertel 18-20, A-1090 Vienna, Austria. Tel.:þ ; fax: þ address: (L.-P. Kamolz). Vollständige Studie abrufbar unter: The classical procedure for the coverage of full-thickness skin defects caused due to trauma or surgery is autologous skin grafting. However, poor skin quality and scar contracture occur frequently and are well-known problems in splitskin grafted areas. Moreover, in functional, strained regions with high requirements of elasticity, pliability and stability such as the wrist or the hand region, it is very important to /$ - see front matter ª2008 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved. doi: /j.bjps

7 Studie zu MatriDerm im Unfallchirurg 2011 Einzeitige Defektdeckung von denudiertem Knochen und freiliegenden Sehnen mittels MatriDerm und Spalthaut Vollständige Studie abrufbar unter:

8 Studie zu MatriDerm Neck Contracture ReleaseWith Matriderm Collagen/Elastin Dermal Matrix Neck Contracture Release With Matriderm Collagen/Elastin Dermal Matrix John E. Greenwood AM, BSc(Hons), MBChB, MD, FRCS(Eng), FRCS(Plast), FRACS, a and Ian P. Mackie MBBS, MD, FRCS(Plast) b a Adult Burn Centre, Royal Adelaide Hospital, South Australia; and b Frenchay Hospital, Bristol, United Kingdom. Correspondence: Published March 22, 2011 Aims: To demonstrate success with immediate split-skin graft application over Matriderm dermal matrix in a difficult neck contracture release. Methods: An aggressive neck contracture release, accompanied by complete platysmectomy, was followed by application of Matriderm, split-skin graft, Mepitel, and vacuum-assisted closure (VAC) dressing. Results: At VAC removal (day 7), graft take was almost complete over the dermal matrix and with minor touch-up were complete by day 9 postrepair. Results at 4 months show graft contraction and a marked diminution of the release obtained. The results, however, are still good and the patient is very happy. Conclusion: Immediate grafting over a dermal matrix appears to provide a good solution, with a gentle surgical learning curve, in this difficult postburn scenario. Postrelease contraction is, however, as inevitable as with other techniques. Neck contracture postburn is one of the most difficult burn sequelae to manage. Poor long-term results can follow even extensive release. Disappointing results with split-skin Vollständige grafting Studie seem to have abrufbar their rootsunter: in 3 phenomena the natural contractile tendency of grafts, the pain of release that reduces exercise and splintage compliance while the grafts are in their most contractile phase, and the presence of a vestigial remnant of the panniculus carnosus, the platysma. The effects of this latter structure are tacitly acknowledged but have not been appropriately explained. 1 Surgeons understand that the panniculus carnosus is a thin muscular layer deep to the skin, within the adventitial tissue of hair-bearing mammals. It is vestigial in humans, remaining as the platysma (with its contributions to risorius and other facial muscles), the dartos muscle of the scrotum, the corrugator cutis ani, the subareolar muscle around the nipple, and the (sometime) palmaris brevis muscle in the hand. In humans, the majority of the panniculus carnosus has been lost with evolution (along with most of our hair) leaving a poor substitute, the fatty panniculus adiposus. In this respect, we resemble

9 MatriDerm Type of Wound: Ethiology: Patient: Significant soft tissue loss of the left lower leg and foot with visible tendons and periostal structures of the medial ankle Degloving injury 71-year-old patient This 71-year-old patient suffered a degloving injury of the left lower leg and foot. After operative debridement, there was significantly soft tissue loss with visible tendon and periostal structures of the medial ankle. Angiography showed that the lower leg and foot were only being nourished by an arteriosclerotic tibialis posterior artery. Defect coverage was performed using 1mm MatriDerm in a one-step procedure with unmeshed split skin grafts in combination with one week of negative pressure wound therapy to fix the grafts. Two years after the accident the patient was able to wear normal shoes and clinical gait analysis demonstrated a perfect functional outcome.

10 MatriDerm Type of Wound: Ethiology: Patient: Infected, necrotic full-thickness wound Dog bite 42-year-old patient After one month of pre-treatment of a dog bite in a general hospital (three sessions of debridement, splinting of the fascia and negative wound pressure therapy) the patient was transferred in a specialized clinic with plasticand reconstructive surgery. Pre-operative view, 4 weeks after injury: Wound bed was still necrotic. Day 0: Wide and deep excision of the wound was necessary to avoid further complications. After preparation of an adequate wound bed, dry 1 mm MatriDerm was applied to the wound. After rehydration of MatriDerm a meshed split-thickness skin graft was applied in a one-step procedure. Fixation was performed by sutures. The wound dressing consisted of fatty gauze, bulky dressing and tight bandaging. Day 6 p. o.: First dressing change with a stable wound and excellent take of the autograft. 3 months p.o.: Stable wound closure of the hand. 2 year follow-up: The long-term result demonstrated. Full range of motion of the hand and a good aesthetic outcome.

11 MatriDerm Type of Wound: Ethiology: Patient: Tendon Adhesion. Toe contracted in an upright position on the right foot The tendon problem occurred and developed over a number of years 63-year-old patient Opening of the tendon at the musculus flexor digitorum brevis. Preparation and loosening of the adhesive tissue. Gentle pull through of a small sheet of dry MatriDerm 1mm. Wrapping of the tendon. Final view before wound closure. Currently patient no longer has an incorrect position and is able to wear their own shoes

12 MatriDerm Art der Wunde: Äthiologie: Chirurgische Wunde Basalzell-Karzinom Verlauf: Nach der großflächig operativen Entfernung eines Basalzell-Karzinoms inklusive Periost lagen bei der Patientin große Teile der Karlotte frei. Mit dem Gedanken einen Granulationsrasen züchten zu können, wurde dieser mittels Stanzbohrer mehrfach angebohrt. Nach sechs wöchiger frustraner VAC Therapie fiel die Entscheidung zur einzeitigen Deckung mittels MatriDerm und Spalthaut. Therapie: VAC-Therapie und MatriDerm im einzeitigen Verfahren Ergebnis: Rasche Einheilung der Spalthaut innerhalb von zehn Tagen. Gut belastbares, stabiles und flexibles Gewebe.

13 MatriDerm Type of Wound: Ethiology: Patient: Surgical full-thickness wound Basal cell carcinoma 42-year-old patient Day 0: R0-excision of the carcinoma. The intra-operative view showing the dry application of 1 mm MatriDerm on the wound bed fixed with normal sutures. Immediate coverage of MatriDerm with a fenestrated split-thickness skin graft in a one-step procedure. Afterwards the wound dressing was performed by using fatty gauze, bulky dressing and tight bandaging. Day 14 p. o.: The post-operative view showing a complete wound closure with a full graft take of the transplant. Follow-up 7 months: The reconstructed skin demonstrated excellent elasticity and pliability, characteristics seen by the facial movement of this skin region. The surgeon as well as the patient were satisfied with the functional and aesthetic outcome in this special body region.

14 MatriDerm Art der Wunde: Äthiologie: Patient: Infizierte, nekrotische Wunde Katzenbiss 50 jährige Patientin ohne Komorbiditäten Die primäre Heilung der Wunde verlief vorerst ohne Komplikationen. Aufgrund einer Infektion kam es nach wenigen Wochen zu einer Nekrosenbildung. Nach dem Debridement war die Strecksehne freiliegend. Durch den Einsatz eines dermalen Substitutes (MatriDerm ) konnte in diesem vorliegenden Fall eine offenliegende Sehne mit einer verschiebbaren Hautstruktur (Neodermis), unter Erhaltung der vollen Funktionalität der Sehne, erfolgreich behandelt werden.

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