Enhanced biomechanical outcomes of split-thickness skin grafts with a three-dimensional collagen-elastin matrix in deep second-degree burns: A 12-month comparative study

Abstract

<h4>Background</h4>Split-thickness skin grafting (STSG) remains the standard for deep second-degree burns, but grafted skin often shows suboptimal biomechanical properties. The dermal substitute MatriDerm® may improve elasticity, structural integrity, and long-term function. This study evaluated the safety, feasibility, and biomechanical outcomes of a single-stage application of 1 mm MatriDerm® combined with STSG versus STSG alone in lower-extremity burns.<h4>Methods</h4>In this single-center retrospective cohort study (January 2023-June 2025), 28 patients received 1 mm MatriDerm® with STSG (1:1 mesh, 0.2 mm thickness) and 20 received STSG alone. Standardized 12-month follow-up included Cutometer-based elasticity testing, sebum and temperature measurements, and documentation of surgical outcomes and complications.<h4>Results</h4>Both treatments were safe and feasible; no re-transplantations, additional surgeries, or deaths occurred. Skin temperature and sebum production did not differ significantly between groups. Cutometer analysis showed clear biomechanical advantages with MatriDerm®: reduced residual deformation under repeated stress (p = 0.0011), improved fatigue resistance (p = 0.002), and a lower viscoelastic ratio (p = 0.00021), indicating greater elasticity. Trends toward improved immediate elasticity and lower initial deformation did not reach statistical significance.<h4>Conclusion</h4>A single-stage combination of 1 mm MatriDerm® and STSG is safe and enhances biomechanical skin quality compared to STSG alone. Although physiological parameters remain unaffected, improved elasticity and structural resilience suggest a functional benefit. Larger prospective studies with extended follow-up are needed to confirm these findings and assess long-term effects on scar quality and mobility.