Q: I am inquiring about fixing a scar on the back of my head. I had hair transplantation done on three separate occasions with the typical taking of the grafts from the back of my head. Unfortunately, the transplants did not take very well or look very good after (worse decision I have ever made in my life) and now I just shave my head. But the harvest scar looks terrible and is very wide. My hair doctor said it could not be made to look better but I am thinking (based on the way my transplants turned out) that he is not a very good doctor. I have about some material called Matristem that supposedly can heal wounds so there is no scar. Do you think this will work for my scalp scar revision? Is this a procedure that you do? Also, how does this material work, from a scientific standpoint?
A: The use of MatriStem from the Acell corporation to heal wounds and make incisions and scar revisions look better is a really intriguing concept. The material is novel and one of its preparations is in a powder form, which is a perfect way to incorporate it as part of any wound closure including scar revisions. My ear experience with it is very encouraging and I continue to use it for more and diverse applications in plastic surgery.
From a scientific standpoint, let me provide you with this explanation. The ACell MatriStem bioscaffold appears to provide signals to the host immune system that stimulate an adaptive or accommodative response that is ideal for both wound healing and three-dimensional growth of various cell types. The ACell MatriStem bioscaffold is distinguished from other ECM scaffold technology by its unique bimodal surface characteristics. One surface consists of an intact basement membrane which is especially conducive to epithelial and endothelial cell attachment, proliferation, and differentiation. (a key advantage in applications such as plastic surgery) The opposite surface consists of organized connective tissue comprised of the urinary bladder lamina propria. This surface is ideal for integration into wound bed and host connective tissues, and supports vascular ingrowth. MatriStem implants consist of a collection of both structural and functional proteins (such as Laminin, Collagen type IV and VII) that are arranged in a three-dimensional ultrastructure that is virtually impossible to reproduce in the laboratory. Growth factors native to the tissue layers comprising MatriStem implants, such as vascular endothelial growth factor (VEGF), transforming growth factor beta (TGFβ), platelet derived growth factor (PDGF), bone morphogenic protein 4 (BMP4), and basic fibroblast growth factor (BFGF), are present as the matrix resorbs, and support the growth of new blood vessels and the proliferation of connective tissue cells to facilitate the healing and tissue remodeling process. In the end, the wound or incision heals by making more natural tissue to knit it together rather than a jumbled bunch of scar tissue.
Dr. Barry Eppley
Q: I am a 30 year old African-American female. I have had three breast augmentations and the scar from the first augmentation was too high leaving me with visible scars. My last augmentation left me with even longer and more hypertrophic scars. I have tried laser in the past and I am considering deep resurfacing and then using the ACell micronized particles (Matristem powder) as this may help smooth the skin out. What do you think? The alternative will be to open the scars and redo them but that would not help as I have done 3 boob jobs and still scarred. I would like to give the laser a go and use the particles as I believe that if it can heal a finger without scars it should at least prevent the skin fromover healing and it will heal to a more even tone. Please email me your thoughts.
A: Hypertrophic scars from breast augmentation, even in an African-American female, is not common. But when it does occur, as yours obviously has, it can be a real problem to improve. Searching for another solution than what you tried (scar excision and re-closure) is understandable.
Matristem collagen particles, derived from porcine bladder, is a new wound healing agent that is certainly touted as having regenerative properties. But do not confuse how a fingertip will heal with that of hypertrophic breast scars. Those are two completely different types of wounds and they do not translate in terms of results. Lasering your scars is probably the worst thing that you could do. It would result not only in loss of skin pigment but creates a secondary healing event that is more prone to scar hypertrophy than your prior scar excisions. I doubt that the ‘magic’ of Matristem particles will overcome your body’s robust healing response in that setting.
I would be more enthused about re-doing your scar revision using Matristem particles placed into and between the wound edges at closure. They are then better placed to exert their beneficial effects at the site of where the active wound healing process is occurring.
Dr. Barry Eppley
Q : I have a bad scalp scar from a prior brain surgery that I would like revised. I have read about a product from a company called Acell that says it can make scars heal and look better if put into it at the time of the surgery. I have talked to someone at the company and it sounds very promising. Have you ever heard of it and would you use for my scar revision?
A: The search for ‘pixie dust’ in plastic surgery is both alluring and ongoing. We would love to be able to add something to our surgical wounds and incisions that would make them heal better and scar less. While this is of great interest in plastic surgery, I suspect every other surgical specialty would feel the same.
The company to which you refer is known as ACell, Inc. which has developed an implantable material that exergts its effect through the concept of regenerative technology. The product name is MatriStem which is a bioscaffold derived from porcine tissue. (from their bladders) When implanted into a surgical site or wound, it is resorbed and replaced with normal tissue where scar tissue would normally be expected. It purportedly does this by bypassing the typical inflammatory process of wound healing and inducing the body to heal the wound with tissue that is native to the site rather than just dense scar, It comes in sheets and a powder form (micronized particles). It is this powder form that some may call pixie dust. The product is relatively new and has been used for a diverse range of wounds including partial and full-thickness skin wounds, pressure ulcers, venous stasis ulcers, diabetic ulcers, skin donor sites and grafts, after laser skin resurfacing, burns and traumatic abrasions and lacerations.
The material is certainly easy to place into a wound and could be easily applied at the time of closure of your scalp scar revision. It is also not overly expensive as medical products go. Whether your scar will turn out better as a result of using MatriStem particles is unknown but there is no downside to doing so and it does sound promising.
Dr. Barry Eppley