Reconstruction of hand surgical wounds after correction of pseudo-syndactyly or squamous cell carcinoma resection in patients affected from epidermolysis bullosa: a monocentric experience with a collagen-elastin dermal matrix dermal substitute

Giulia Bernante; Alessandro Portoghese; Mario Lando; Barbara Ferrari; Camilla Reggiani; Raimondo Femino; Chiara Fiorentini; Cristina Magnoni

doi:10.4081/dr.2024.10016

Authors

Giulia Bernante Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Italy. https://orcid.org/0009-0003-1848-762X
Alessandro Portoghese Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Italy. https://orcid.org/0009-0004-1026-5413
Mario Lando Department of Muscle-Skeletal Surgery Hand and Microsurgery, Modena University Hospital, Italy.
Barbara Ferrari Division of Regenerative and Oncological Dermatological Surgery, Modena University Hospital, Italy.
Camilla Reggiani Division of Regenerative and Oncological Dermatological Surgery, Modena University Hospital, Italy.
Raimondo Femino Department of General and Specialist Surgeries, Anesthesia and Intensive Care Unit 2, University Hospital Policlinico of Modena, Italy. https://orcid.org/0000-0003-2421-1710
Chiara Fiorentini Division of Regenerative and Oncological Dermatological Surgery, Modena University Hospital, Italy.
Cristina Magnoni
magnoni.cristina@gmail.com
Division of Regenerative and Oncological Dermatological Surgery, Modena University Hospital, Italy.

In patients with Epidermolysis Bullosa (EB), surgery may be required to remove Squamous Cell Carcinoma (SCC) of the hands or to correct pseudo-syndactyly. Dermal substitutes may represent a suitable tool to promote the healing of surgical wounds in EB. We review our experience with a collagen-elastin dermal matrix to promote surgical wound healing due to hand surgery to correct pseudo-syndactyly or SCC resection in patients affected by EB.
Overall, 12 patients (mean age, 29±11 years, range 13-51; four females) with EB were considered, with a total of 25 different interventions (16 SCC removals; three amputations for recurrent infiltrating SCC; six pseudo-syndactyly corrections). All patients received a collagen-elastin dermal matrix sheet. Neodermis was achieved in all patients, and no adverse events potentially associated with the graft occurred. No SCC recurrence was reported at sites operated for either SCC resection or amputation. The opening of the first or second commissure appears to be maintained for over 1 year after the procedure, preserving digital function.
We believe that the application of a dermal substitute, together with a close dressing protocol, may represent a suitable strategy for obtaining physiological tissue regeneration and maintaining proper hand function in patients with EB.

Natsuga K, Shinkuma S, Hsu CK, et al. Current topics in epidermolysis bullosa: pathophysiology and therapeutic challenges. J Dermatol Sci. 2021;104:164-76. DOI: https://doi.org/10.1016/j.jdermsci.2021.11.004

Box R, Bernardis C, Pleshkov A, et al. Hand surgery and hand therapy clinical practice guideline for epidermolysis bullosa. Orphanet J Rare Dis. 2022;17:406. DOI: https://doi.org/10.1186/s13023-022-02282-0

du Rand A, Hunt JMT, Feisst V, Sheppard HM. epidermolysis bullosa: a review of the tissue-engineered skin substitutes used to treat wounds. Mol Diagn Ther. 2022;26:627-43. DOI: https://doi.org/10.1007/s40291-022-00613-2

Abboud L, Leclerc-Mercier S, Bodemer C, Guéro S. Hand surgery in recessive dystrophic epidermolysis bullosa: our experience with dermal substitutes. J Plast Reconstr Aesthet Surg. 2022;75:314-24. DOI: https://doi.org/10.1016/j.bjps.2021.05.056

Condorelli AG, Dellambra E, Logli E, et al. epidermolysis bullosa-associated squamous cell carcinoma: from pathogenesis to therapeutic perspectives. Int J Mol Sci. 2019;20:5707. DOI: https://doi.org/10.3390/ijms20225707

Paganelli A, Reggiani C, Fiorentini C, et al. Surgical management of squamous cell carcinoma arising in patients affected by epidermolysis bullosa: a comparative study. Int Wound J. 2020;17:519-21. DOI: https://doi.org/10.1111/iwj.13306

Rotschein P, Vokurková J, Bučková H. Surgical treatment and management of cutaneous squamous cell carcinoma in patients with dystrophic epidermolysis bullosa - a case report. Acta Chir Plast. 2021;63:196-200. DOI: https://doi.org/10.48095/ccachp2021196

Tchero H, Herlin C, Bekara F, et al. Failure rates of artificial dermis products in treatment of diabetic foot ulcer: A systematic review and network meta-analysis. Wound Repair Regen. 2017;25:691-6. DOI: https://doi.org/10.1111/wrr.12554

Dickson K, Lee KC, Abdulsalam A, et al. A Histological and clinical study of MatriDerm® use in burn reconstruction. J Burn Care Res. 2023:irad024. DOI: https://doi.org/10.1093/jbcr/irad024

Hones KM, Hones J, Satteson ES, Chim H. Treatment of complex extremity wounds with MatriDerm: first clinical experience in the US. J Wound Care. 2023;32:167-71. DOI: https://doi.org/10.12968/jowc.2023.32.3.167

Paganelli A, Naselli AG, Bertoni L, et al. Wound healing after acellular dermal substitute positioning in dermato-oncological surgery: a prospective comparative study. Life (Basel). 2023;13:463. DOI: https://doi.org/10.3390/life13020463

Salloum A, Bazzi N, Squires S, et al. Comparing the application of various engineered xenografts for skin defects: a systematic review. J Cosmet Dermatol. 2023;22:921-31. DOI: https://doi.org/10.1111/jocd.15517

De Angelis B, Gentile P, Agovino A, et al. Chronic ulcers: MATRIDERM(®) system in smoker, cardiopathic, and diabetic patients. J Tissue Eng. 2013;4:2041731413502663. DOI: https://doi.org/10.1177/2041731413502663

Mandel VD, Persechino F, Fiorentini C, et al. Treatment of chronic infected post-oncological wounds with a dermal matrix: two case studies. J Wound Care. 2018;27:558-62. DOI: https://doi.org/10.12968/jowc.2018.27.9.558

Abbate V, Iaconetta G, Sani L, et al. The use of dermal substitutes for donor site closure after radial forearm free flap harvesting. J Craniofac Surg. 2021;32:e205-8. DOI: https://doi.org/10.1097/SCS.0000000000006808

Campagnari M, Jafelicci AS, Carneiro HA, et al. Dermal substitutes use in reconstructive surgery for skin tumors: a single-center experience. Int J Surg Oncol. 2017;2017:9805980. DOI: https://doi.org/10.1155/2017/9805980

Charvillat O, Plancq MC, Haraux E, et al. Aplasia cutis congenita of both knees: a new therapeutic strategy. Arch Pediatr. 2020;27:277-80. DOI: https://doi.org/10.1016/j.arcped.2020.05.007

Duteille F, Truffandier MV, Perrot P. ‘Matriderm’ dermal substitute with split-thickness skin graft compared with full-thickness skin graft for the coverage of skin defects after surgical treatment of congenital syndactyly: results in 40 commissures. J Hand Surg Eur Vol. 2016;41:350-1. DOI: https://doi.org/10.1177/1753193415594101

Jackson SR, Roman S. matriderm and split skin grafting for full-thickness pediatric facial burns. J Burn Care Res. 2019;40:251-4. DOI: https://doi.org/10.1093/jbcr/irz006

Fulchignoni C, Rocchi L, Cauteruccio M, Merendi G. Matriderm dermal substitute in treating post traumatic hand's fingertip tissue loss. J Cosmet Dermatol. 2022;21:750-7. DOI: https://doi.org/10.1111/jocd.14115

Mellerio JE, Robertson SJ, Bernardis C, et al. Management of cutaneous squamous cell carcinoma in patients with epidermolysis bullosa: best clinical practice guidelines. Br J Dermatol. 2016;174:56-67. DOI: https://doi.org/10.1111/bjd.14104

Véliz S, Huber H, Yubero MJ, et al. Early teeth extraction in patients with generalized recessive dystrophic epidermolysis bullosa: a case series. Spec Care Dentist. 2020;40:561-5. DOI: https://doi.org/10.1111/scd.12515

Polizzi A, Santonocito S, Patini R, et al. Oral alterations in heritable epidermolysis bullosa: a clinical study and literature review. Biomed Res Int. 2022;2022:6493156. DOI: https://doi.org/10.1155/2022/6493156

van den Heuvel I, Gottschalk A, Langer M, et al. Feasibility, efficacy, and safety of ultrasound-guided axillary plexus blockade in pediatric patients with epidermolysis bullosa dystrophica. Paediatr Anaesth. 2016;26:405-8. DOI: https://doi.org/10.1111/pan.12860

Zhou X, Zhang Y, Zhao M, et al. Surgical management of hand deformities in patients with recessive dystrophic epidermolysis bullosa. J Plast Surg Hand Surg. 2020;54:33-9. DOI: https://doi.org/10.1080/2000656X.2019.1661846

Bellei B, Govoni FA, Bertozzi E, et al. Restoring full-thickness skin defects with a dermal regeneration template and dermal-epidermal cell suspension in a patient with junctional epidermolysis bullosa. Eur J Dermatol. 2020;30:3722. DOI: https://doi.org/10.1684/ejd.2020.3722

Supporting Agencies

This work was made possible by an unrestricted grant from MedSkin. This work is generated within ERN-Skin.

Bernante, G., Portoghese, A., Lando, M., Ferrari, B., Reggiani, C., Femino, R., Fiorentini, C., & Magnoni, C. (2024). Reconstruction of hand surgical wounds after correction of pseudo-syndactyly or squamous cell carcinoma resection in patients affected from epidermolysis bullosa: a monocentric experience with a collagen-elastin dermal matrix dermal substitute. Dermatology Reports. https://doi.org/10.4081/dr.2024.10016