MatriDerm_DFU_Hospital_Management_Presentation - Dr. Ankush copy.pptx

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1. Advancing Diabetic Foot Ulcer Management Dr. Ankush Tambotra Plastic & Reconstructive Surgeon

2. Burden of Diabetic Foot Ulcers (DFU) 15–25% of diabetics develop DFU during their lifetime Globally a leg is amputed every 30 seconds due to DFU High recurrence, slow healing, infection risk Leading cause of non-traumatic amputations ↑ Hospital stay, ↑ costs, ↓ quality of life

3. Challenges in DFU Wound Healing Chronic ischemia & neuropathy Poor granulation over exposed tendon/bone High infection & osteomyelitis risk Risk of amputation when reconstruction fails

4. Current Treatment Gaps Conventional dressings inadequate for deep DFUs Skin grafts fail on poorly vascularized beds Flap surgeries = Microsurgery, high donor site morbidity, resource-intensive Need for biologic matrix supporting regeneration

5. Dermal Substitutes in Diabetic Foot Ulcers

6. What are Dermal Substitutes

7. 7 Collagen Elastin Template Matriderm ®

8. 8 What is MatriDerm ® Dermal Matrix No chemical cross- linking Made of native collagen fibers Contains elastin MatriDerm ® is a  unique collagen-elastin-template , which serves as a dermal replacement scaffold and can be applied both in a  One - and Multi- Step Procedure . Open porous structure

9. Value addition of MatriDerm ® Dermal Matrix 9 Preserves closeness to Human Dermis Limits Myofibrolast formation & contractures Improved functional outcomes Unique Native Collagen – Elastin Matrix Elastin function Patented Advanced Cryosafe Technology Single step procedure Clinically Validated Accelerates Revascularization Accelerates Cell invasion, proliferation

10. ©MedSkin Solutions Dr. Suwelack AG | Confidential 10 3 Elastin Native collagen fibers No chemical cross-linking Triggers early vascularization and allows for early elasticity of new skin Enables early physical therapy and rehabilitation Improved healing by native collagen Improved cell migration and reconstruction of new dermis No -release of cell-toxic substances Improved cellular growth One-Step Procedure Reduced operation time and hospital costs Reduced patient morbidities Much lower risk of infection 1 2 The MatriDerm ® Difference: 4

11. ©MedSkin Solutions Dr. Suwelack AG | Confidential The ideal Dermal Matrix… P reserve A ccelerate L imit Closeness to Human Dermis Cell Invasion, Elongation & Proliferation Myofibroblast Formation & Contraction

12. © MedSkin Solutions Dr. Suwelack AG | Confidential 12 Material matters – giving the cells a known environment Fibril structure Human Dermis MatriDerm ® Dill, V. and Mörgelin, M. Int Wound J 2020;17(3):618-630. Data on file. ©MedSkin Solutions Dr. Suwelack AG | Confidential native ✅ Native collagen ✅ Native collagen and fibril structure are both preserved in MatriDerm

13. © MedSkin Solutions Dr. Suwelack AG | Confidential 13 Material matters – giving the cells a known environment Fibril structure Human Dermis Collagen GAG Collagen MatriDerm ® denatured Dill, V. and Mörgelin, M. Int Wound J 2020;17(3):618-630. Data on file. ©MedSkin Solutions Dr. Suwelack AG | Confidential Polyurethane synthetic native ✅ ❌ ❌ ❌ Native collagen ✅ ❌ ❌ ❌ Native collagen and fibril structure are both preserved in MatriDerm

14. Infection Rate (%) MatriDerm 0-5% 5,6,7 Synthetic Polyurethane 19-39% 1,2 Denatured Collagen 16–42% 3,4 Denatured MatriDerm Fast vascularization Fast integration Synthetic Lowering Infection Rates (1) Liu, X. et al . (2019) J Burn Care & Res . 40(1):S209-10; (2) Lo, CH. et al . (2022) Burns . 48(3):529-38. (3) Heimbach, DM. et al . (2003) J Burn Care Rehabil . 24(1):42-8; (4) Bargues , L. et al . (2009) Ann Chir Plast Esthet . 54(6):533-9; (5) Pauchot , J. et al . (2012) Dermatol Surg . 39(1):43-50; (6) Wallner, B. et al . (2022) Eur J Trauma Emerg Surg . 49(1):551-7; (7) Phillips, GSA. et al . (2020) Ann Burns Fire Disasters . 33(3):245-52 14

15. Why MatriDerm ® in DFU’s? Promotes vascularization in ischemic wounds Stimulates granulation on exposed tendon/bone Reduces infection risk with rapid coverage Single-stage closure → shorter hospital stay Durable, pliable coverage for function & mobility

16. Key Clinical Benefits of MatriDerm ® in DFU’s Stable coverage over exposed structures Faster wound closure vs dressings Reduces need for flaps in high-risk patients Better graft take in compromised beds Improved cosmetic & functional outcomes

17. ©MedSkin Solutions Dr. Suwelack AG | Confidential 17 Clinically Validated Over 200 publications on the efficacy of MatriDerm ® 12 year follow- up study Long-lasting effect on scar quality by the use of MatriDerm ® – even after 12 years: Improved scar parameter 1 Improved scar appearance (cosmetic) 1 A product you can trust Abstracts of main publications can be found at www.matriderm.com ( Bibliography ) 1. Bloemen MC et al., Plast Reconstr Surg , 2010, 125(5):1450-9

18. MatriDerm ® Clinical Evidence & Case Outcomes Studies show improved healing & limb salvage Latest study (Jeon et al., Arch Plast Surg 2013) Improved elasticity in DFUs (n=60 patients) Multiple case reports: rapid granulation + STSG success

19. 19 Krasteva , ES. et al. (2023) Albanian J Truma Emerg Surg. 7(2):1240-4 Treatment of challenging wounds: Traumatic wounds with bone exposure Chronic wounds – with high risk of flap failure MatriDerm ® < 4 weeks STSG alone 8 weeks Reduction of hospitalization times

20. Reduction in Costs Through Quicker Discharge from Hospital 20 Faster Healing and Shorter Hospital Stay 1 1. Jeon et al., 2013 Arch Plast Surg;40:403-408. *Split- Thickness Skin Graft  23% reduction in hospital stay on average

21. Candidates to flap surgery 21 (1) Alawi, SA. et al ., (2024). J of Wound Care. 33(1):14-21 Requiring flap surgery Exposed structures Disease-related wounds Non-healing acute or chronic wounds All treated with MatriDerm No need of flap surgery (77,5%) Requiring flap surgery (22,5%) A Potential Alternative to Invasive Surgery Even in severe cases that traditionally require flap surgery, MatriDerm ® + STSG could save ~80% of cases from flap procedures, hence representing a valid treatment option in the reconstructive ladder. Study: Single-center, retrospective follow-up study. Complex or complicated wounds: exposed structures, wounds based on diseases (like chronic venous insufficiency or diabetes), and acute or chronic injury not responding to treatment.

22. (1) Ryssel, H. et al. (2008) Burns . 34:93-7 (2) Kamolz, LP. Presentation ISBI Meeting Montreal 2008 MatriDerm Restores Skin E lasticity MatriDerm restores Elasticity to the level of healthy skin * Finger-tip-palmar crease-distance (FDP) 1 Distance (cm) n = 18 p < 0,005 22 Extension Retraction Healthy skin MatriDerm + STSG STSG n = 10 Elasticity 2 Elasticity (mm) Time (s)

23. ©MedSkin Solutions Dr. Suwelack AG | Confidential 23 Entering the matrix – key takeaways Material Native Collagen ( MatriDerm ) Denatured Collagen Synthetic Polyurethane Pore size 22-51 µm 1 40-220 µm 2 300-900 µm 2 Vascularization 5 days > 2 weeks > 3 weeks Grafting time 1-stage ✅ 2-stage ✅ 5+ days ( depending on thickness , staging ) 1-stage ❌ 2-stage ✅ after 14-21 days 1-stage ❌ 2-stage ✅ after > 35 days Infection rate 2-5% 3,4,5 16-32% 6,7 19-39% 8,9 MatriDerm ® offers an optimal pore size and surface for wound healing 1. Dill, V. and Mörgelin, M. Int Wound J 2020;17(3):618-630. 2. Stefanelli et al., Health Sci Rep. 2023 Aug 1;6(8):e1462. 3. Pauchot et al. Dermatol Surg . 2013; 39(1 Pt 1):43-50 4. Wallner et al. L Eur J Trauma Emerg Surg . 2023 49(1):551-557 5. Phillips et al. Ann Burns Fire Disasters . 2020; 33(3):245-252. Fibroblast size : 10-15 µm 6. Heimbach et al. J Burn Care Rehabil . 2003;24(1):42-48 7. Bargues et al. Ann Chir Plast Esthet . 2009;54(6):533-539. 8. Liu et al. 473 Journal of Burn Care & Research. 2019; 40(1): S209–S210. 9. Lo et al. Burns. 2022;48(3):529-538.

24. Economic & Institutional Benefits Reduced re-hospitalization & prolonged wound care Lower amputation rates = major cost savings Shorter hospital stay, faster rehab Enhances hospital reputation as DFU centre of excellence

25. Conclusion & Call to Action DFU remains a major healthcare challenge MatriDerm® offers a proven, effective solution Improves patient outcomes & reduces hospital burden Recommendation: Incorporate MatriDerm into DFU protocols

26. Clinical Evidence 26 ©MedSkin Solutions Dr. Suwelack AG | Confidential

27. 27 Diabetic Foot Syndrome with Gangrene CHRONIC WOUNDS Type of Wound Gangrene of the right foot Etiology Diabetic foot syndrome in an obese patient with a gangrenous right foot Patient 60-year-old male Courtesy of D. Luedi , MD, Langenthal, Switzerland 6 months post-operative

28. 18-007 Diabetic Foot Syndrome with Gangrene Courtesy of D. Luedi , MD, Langenthal, Switzerland A 60-year-old male with diabetic foot syndrome and a history of obesity and coronary heart disease, presented with a gangrenous right foot. An emergency bedside debridement was performed, and IV antibiotics were started. At the following surgical debridement, the 5th metatarsal bone was resected. The wound was further debrided with the use of maggots. The wound bed was prepared with gauze-based Negative Pressure Wound Therapy (NPWT), which was set at 120 mmHg.

29. 18-007 Diabetic Foot Syndrome with Gangrene Courtesy of D. Luedi , MD, Langenthal, Switzerland At the time of wound closure, the excess granulation tissue was removed and a dry sheet of 1 mm MatriDerm ® Dermal Matrix was applied on the wound bed. MatriDerm ® Dermal Matrix was then moistened with Ringer’s lactate (Fig. 3). A split-thickness skin graft immediately followed in a One-Step Procedure (Fig. 4).

30. 18-007 Diabetic Foot Syndrome with Gangrene Courtesy of D. Luedi , MD, Langenthal, Switzerland A non-adherent wound contact layer was placed over the skin graft and the graft was fixated with NPWT. After 7 days, NPWT was ceased and the skin graft demonstrated good take rate and healing. The wound was dressed with fatty gauze dressings. 2 months post-operatively , wound healing had progressed well.

31. 18-007 Diabetic Foot Syndrome with Gangrene Courtesy of D. Luedi , MD, Langenthal, Switzerland Wound showed stable wound closure and the patient was able to walk with a diabetic shoe. 3-month post-operative 6-month post-operative

32. 32 Chronic Diabetic Ulcer at Clubfoot CHRONIC WOUNDS Type of Wound Chronic diabetic foot ulcer Etiology Neuropathic cavoid foot ; idiopathic clubfoot ; chronic infected ulceration Patient 47-year-old male 6 months post-operative Courtesy of H. Mössner , MD, Salzburg, Austria / Medihoney by Derma Sciences , Inc / Hyiodine by Contipro Group s.r.o

33. 18-007 Chronic Diabetic Ulcer at Clubfoot Courtesy of H. Mössner , MD, Salzburg, Austria / Medihoney by Derma Sciences, Inc / Hyiodine by Contipro Group s.r.o Patient with a neuropathic cavoid foot and an idiopathic clubfoot has a 4-year history of infected ulcerations on the plantar and lateral dorsal side of the foot. In the weeks prior to the reconstructive surgery, the Pseudomonas-infected ulcer was treated with MediHoney to control the infection. The wound bed was optimized with Hyiodine . At the day of surgery, the infection was resolved and the wound size was reduced. The ulcer was thoroughly debrided resulting in a well vascularized wound bed.

34. 18-007 Chronic Diabetic Ulcer at Clubfoot Courtesy of H. Mössner , MD, Salzburg, Austria / Medihoney by Derma Sciences, Inc / Hyiodine by Contipro Group s.r.o MatriDerm ® Dermal Matrix was applied and in a One-Step Procedure covered with a meshed split-thickness skin graft which was sutured to the wound edges . Negative pressure wound therapy (NPWT) was initiated to immobilize the graft.

35. 18-007 Chronic Diabetic Ulcer at Clubfoot Courtesy of H. Mössner , MD, Salzburg, Austria / Medihoney by Derma Sciences, Inc / Hyiodine by Contipro Group s Result 5 days post-operative : signs of initial graft integration were observed. Result 6 months post-operative : the wound was completely closed with good tissue elasticity and mobility. The patient was pain free.

36. 36 Chronic Mixed Ulcer in Diabetic Patient CHRONIC WOUNDS Type of Wound Chronic mixed ulcer of the forefoot Etiology Diabetic patient with mixed ulcers repeatedly covered with split skin Patient 70-year-old patient 2 weeks post-operative Courtesy of M. Öhlbauer , MD, Murnau, Germany

37. 37 Chronic Mixed Ulcer in Diabetic Patient Courtesy of M. Öhlbauer , MD, Murnau, Germany Afterwards 1 mm MatriDerm ® Dermal Matrix was applied in a One-Step Procedure. The 70-year-old patient suffers from a mixed chronic ulcers. The wound bed was debrided and conditioned for 2 – 3 weeks. CHRONIC WOUNDS An unmeshed split-thickness skin graft (STSG) was placed on top of the matrix. Afterwards Negative Pressure Wound Therapy (NPWT) was applied.

38. 38 Chronic Mixed Ulcer in Diabetic Patient Courtesy of M. Öhlbauer , MD, Murnau, Germany Result 2 weeks after the surgical procedure. Result 1 week after the surgical procedure. CANCER EXCISION