Wound healing and the science behind it is an integral part of plastic surgery. No medical specialty is faced with more diverse wound healing challenges being a referral source for difficult and non-healing surgery sites and wounds. Plastic surgery offers a wide spectrum of wound healing methods from tissue flaps, skin and fat grafting to topical therapies. One exciting new technology is an advanced regenerative medical implant that can be used as a either a topical application, an injectable slurry or as a surgical implant. Developed by the Acell company, MatriStem technology is a bioscaffold material derived from porcine tissue. When MatriStem is implanted into a surgical site or wound, it is resorbed and replaced with new natural tissue and less scar than would normally occur if it was not used.
MatriStem is a non-synthetic implant that is completely resorbable and acellular. It is a unique implant because of the way it induces healing by triggering extensive new blood vessel formation and recruiting specific cell types to heal the wound site. These cells have the potential to become tissue that is natural to the specific tissue site rather than undifferentiated scar tissue. During the healing process, the implant material is completely resorbed, leaving behind natural tissue replacement and not just scar or an integrated but unnatural residual implant. While no implant yet exists that can completely eliminate scar tissue formation, Matristem substantially reduces the amount of scar that can form in any wound. Less scar means more natural tissue replacement which could show less visible white scar and more normal movement and function around the wound or surgery site.
MatriStem is currently available in both sheet and micronized particle form. (powder) The availability of these two forms allows the material to be applied in any conceivable wound application. It can be used for the treatment of a wide variety of either chronic non-healing wounds or in primary acute surgery to facilitate faster recovery and better results. It may also be valuable in a wide variety of numerous reconstructive and cosmetic plastic surgery applications.
How does the MatriStem implant work? Current scientific understanding is that the scaffold material provides stimulation to the recipient’s immune system to recruit specific cell types for a three-dimensional repair with tissue that is indigenous to the area. The MatriStem bioscaffold is distinguished from other extracellular scaffold technology by its unique two layer or bimodal surface structure. One surface consists of an intact basement membrane which is especially conducive to epithelial and endothelial cell attachment, proliferation, and differentiation. The opposite surface consists of organized connective tissue comprised of the urinary bladder lamina propria. This surface allows for integration into the recipient’s connective tissues and supports blood vessel ingrowth as well. MatriStem implants consist of a both structural and functional proteins (such as Laminin, Collagen type IV and VII) that are arranged in a three-dimensional ultrastructure that is very difficult to reproduce in any manufactured synthetic implant. Growth factors native to MatriStem implants include vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF?), platelet derived growth factor (PDGF), bone morphogenic protein 4 (BMP4), and basic fibroblast growth factor. (BFGF) These are present as the implant resorbs and accounts for why new blood vessels and the recruitment of connective tissue cells occurs to facilitate the healing and tissue remodeling process.
For non-healing wounds, Matristem may be useful either alone or in combination with conventional surgical treatment methods. (debridement and wound closure or grafting) Scars may be improved by excision and interposition of the powder form between the wound edges at closure. Matristem offers promise as an adjunct to injectable fat grafting and open bone grafting. As a slurry, it may be also useful as an injectable method of collagen stimulation particularly if mixed with platelet-rich plasma. (PRP)
Dr. Barry Eppley
Indianapolis, Indiana