How to Select an Extracellular Matrix for Wound Repair: A Comprehensive Review

Area of Science:

• Biomaterials Science
• Regenerative Medicine
• Wound Care

Background:

• Extracellular matrix (ECM) products have evolved since 1930 to improve wound healing, minimize scarring, and reduce pain.
• Physician selection of ECMs is currently based on experience and patient-specific factors, lacking comprehensive comparative data.
• A need exists for a thorough investigation comparing the majority of available ECMs for wound healing efficacy.

Purpose of the Study:

• To conduct a literature review to identify the optimal extracellular matrix (ECM) for wound healing and positive patient outcomes.
• To compare indications, advantages, and disadvantages of various ECMs to guide clinical selection.
• To provide an evidence-based approach to ECM selection in wound care.

Main Methods:

• A literature review was performed using the PubMed database, analyzing 71 articles.
• Primary search terms included "extracellular matrix," "xenograft," "allograft," "bioengineered matrix," "acellularized fish skin," and "wound healing."
• The review focused on clinical trials, case series, and other review articles, evaluating popular ECMs.

Main Results:

• Allografts are suitable but inferior to bioengineered matrices, porcine/bovine xenografts, and acellularized fish skin (AFS) in healing rate and quality.
• Bioengineered matrices and xenografts offer antimicrobial properties, low immunogenicity, and cost-effectiveness but have limitations in healing time and cosmesis.
• AFS demonstrates superior healing times and cosmetic results, with antimicrobial and low immunogenicity benefits, though accessibility and cost are potential drawbacks.

Conclusions:

• This review provides a guide to ECM selection, reducing subjectivity in clinical decision-making.
• Further head-to-head trials are recommended to develop a more algorithmic approach to wound healing selection.
• Implementing objective measures like the Disabilities of the Arm, Shoulder, and Hand (DASH) score in future trials is suggested.