A Retrospective Comparison of Animal-Derived vs. Fully Synthetic Skin Substitutes in Plastic Surgery: Assessing Functional, Aesthetic, and Economic Metrics
Timothy Olsen*, Safi Ali-Khan, Derek Bell
University of Rochester Medical Center, Rochester, NY
Integra® Dermal Regeneration Template and Integra's PriMatrix® are established bovine collagen-based dermal templates (DT) for treating wounds and reconstructing soft tissue defects but have high costs and infection risks. PolyNovo's fully synthetic polyurethane bilayer matrix, NovoSorb® BTM, is a cost-effective alternative to Integra's animal-derived matrix, but there lacks sufficient data for comparison. Therefore, our study compared Integra's animal-derived matrix (ADM) outcomes to PolyNovo's fully synthetic matrix (FSM) in treating soft-tissue wounds.
An IRB-approved retrospective study was performed on patients who underwent wound reconstruction with either ADM or FSM skin substitutes between January 2011 and September 2022. We collected patient-level data and outcomes, including closure time, complications, and measures of healthcare strain associated with treatment costs, readmissions, and follow-up visits. In addition, the Vancouver scar assessment was used to quantify aesthetic differences.
Our study included 32 patients (36 cases): 21 (57.1%) ADM and 15 (42.9%) FSM. Mean age at the time of DT treatment was 40.8+/-17.1 years. There were no significant differences in patient demographics, smoking status, medical comorbidities, defect size, etiologies, surgery lengths, or time between DT placement and autografts between groups. Mean time to complete wound closure was significantly longer for patients treated with ADM (122 vs. 63 days, p = 0.045). ADM had higher infection rates, wound hypertrophy, and readmissions for revisionary surgeries (p = .012, .014, .002, respectively). ADM scars were more likely to turn red (1.70 vs. .83 mean vascularity scores, p = .016). Despite initially equivalent defect sizes, the total cost of DT implants on average for the ADM group equaled $6,376.72 compared to FSM mean of $2,493.33 (p = .027).
Our study suggests that PolyNovo's FSM provides improved functional, aesthetic, and economic metrics compared to Integra’s existing ADM skin substitutes for treating soft-tissue wounds and warrants further investigation.
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