Pilot Study: Dermal Regenerative Templates for Complex Wound Management: Adding a New Rung to the Reconstructive Ladder

Background: Skin grafting with dermal regenerative templates (DRTs) has emerged as an effective option within the reconstructive ladder for coverage of full-thickness wounds. This approach reduces the need for flap reconstruction, shortens hospitalization, and minimizes wound-related morbidity while improving functional and aesthetic outcomes. We present a case series of patients treated with a novel hydrogel-based DRT (hDRT) composed of type I bovine collagen microspheres embedded within a lower density type I bovine collagen hydrogel. We describe outcomes of wounds treated using this template. Methods: A retrospective chart review of patients who underwent definitive coverage of full-thickness skin defects with an hDRT was performed. Results: Thirteen defects in 10 patients underwent reconstruction. Defect locations included the face, scalp, and extremities. Wound etiologies included oncological, traumatic, and donor-site defects. Exposed tissues included tendon, bone, nerve, and galea. Defect size ranged from 2 to 100 cm 2 . Wounds were managed using hDRT with immediate skin grafting, hDRT with delayed skin grafting, and hDRT alone without grafting. All patients displayed wound bed vascularization 8 days after application. Mean total time to healing ( T total ) was 8 days for immediate skin grafting, 15 days for delayed skin grafting, and 18 days for secondary intention. All healed defects were aesthetically acceptable, with minimal to no contour deformity. Conclusions: This novel dual-density hDRT demonstrated favorable results in wound reconstruction as a result of accelerated vascularization leading to reduced treatment time and patient morbidity. Larger studies are required to compare the efficacy with other products on the market.