Defining dermal matrices: Results of a global Delphi panel in surgical reconstruction

Dermal matrices are increasingly used in reconstructive surgery to manage complex soft-tissue defects, yet inconsistent terminology and variable product characteristics hinder their clinical and regulatory standardization.

To establish international expert consensus on the definition, essential features, and clinical role of dermal matrices in surgical reconstruction using a structured Delphi methodology.

A two-round Delphi process was conducted. A Steering Committee of 11 specialists developed and refined 41 statements based on a literature review and clinical experience. These were rated by a global panel of experts using a 5-point Likert scale. Consensus was defined as ≥75% agreement (scores of 4 or 5). Statements not reaching consensus were revised or removed and presented in a second round.

Of 70 experts invited, 43 participated in round one and 36 in round two. Consensus was achieved on 34 statements, addressing definitions, biomaterial safety, biological functions (e.g., cell adhesion, vascularization), and clinical outcomes (e.g., reduced scarring, neodermis formation). Key areas lacking consensus included the role of synthetic components, inclusion of specific extracellular matrix constituents, optimal degradation time, pore size thresholds, and barrier function. These gaps reflect variability in product performance and a lack of comparative data.

This Delphi panel established a foundational framework for defining and evaluating dermal matrices in reconstructive surgery. While consensus was achieved on many core principles, areas of uncertainty highlight the need for further comparative studies to guide evidence-based practice and product innovation.