This Masterclass guide is a concise overview aimed at exploring the use of a clinically advanced product called Cytal® Wound Matrix in wound management solutions and how to incorporate this into your practice.
What is Cytal® Wound Matrix?
■ Cytal® Wound Matrix stems from the Urinary Bladder Matrix (UBM) technology. It is a sterile, porcine-derived, lyophilized naturally occurring extracellular matrix (ECM) in a 2D sheet form that facilitates the management of complex wounds.
■ Integra's UBM technology is an ECM scaffold that supports a transition of the host immune response from a scarringtype response to a remodeling response that facilitates deposition of vascularized, site-appropriate tissue, tissue that closely resembles the original tissue, both structurally and functionally1,2
■ Cytal® Wound Matrix has been associated with a modified inflammatory response: it provides an environment where the body is more likely to exhibit a higher ratio of M2 (proremodeling) to M1 (proinflammatory) macrophages, which may “kick-start” wound healing 1,2,4 .
■ Cytal® Wound Matrix has been designed for complex wounds. It is available in a range of layering configurations and sizes with varying resorption profiles which allow to adapt to the treatment to the targeted wound. Cytal® Wound Matrix is conformable to allow for intimate contact with the wound bed. Its prefenestrated design supports effective fluid management and wound drainage
■ Cytal® Wound Matrix is appropriate for acute wounds (including trauma wounds and second-degree burns) and chronic wounds and may be used alone or concomitantly with powdered collagen-based dermal matrices.
Cytal® Wound Matrix supports wound healing and tissue deposition by providing a temporary collagen scaffold that facilitates cellular infiltration, supports angiogenesis1,4,5,6 and modulates inflammation1,2,3.
■ Provides a Structural Scaffold: Cytal® Wound Matrix stems from porcine UBM Technology, which is rich in collagen – a key structural protein in the human body. When applied to a wound, this three-dimensional scaffold acts as a temporary framework where cells can adhere, migrate, and proliferate supporting the deposition of new tissue1,4,5,6
■ Features a collagen-based structure that supports the body's wound healing process and the deposition of site-appropriate tissue, with function and structure similar to normal tissue1,7-12
■ Modulates the Inflammatory Response: the host response to MicroMatrix® Dermal Repair Powder has been shown to quickly transition from an initial pro-inflammatory response toward a more proremodeling immune response1,2
■ Facilitates Cellular Proliferation and extracellular matrix Deposition: the presence of MicroMatrix® Dermal Repair Powder supports the proliferation of cells and production of new extracellular matrix (ECM) proteins1,3,13.
■ Provides a Site for Vascular Ingrowth: the collagen scaffold allows for the migration and attachment of endothelial cells into the scaffold necessary for the formation of new capillaries, and integration into the existing blood supply1,3,13
■ Mitigates the Complexity of Reconstructive Surgery7,8 as it may be used over exposed avascular structures7,8 Cytal® Wound Matrix Facilitates rapid primary closure7,8,9 and may support limb salvage7,9,1
Figure 1: Cytal® Wound Matrix
Extracellular Matrix (ECM) Products
Cytal® Wound Matrix
Urinary Bladder Matrix [UBM] Technology
What Types of Wounds are Suitable?
Cytal® Wound Matrix is indicated for the management of wounds including: partial and full-thickness wounds, pressure ulcers, venous ulcers, diabetic ulcers, chronic vascular ulcers, tunneled/undermined wounds, surgical wounds (donor sites/grafts, post-Mohs surgery, post-laser surgery, podiatric, wound dehiscence), trauma wounds (abrasions, lacerations, second-degree burns, skin tears), and draining wounds.
Examples of Clinical Wounds suitable for Cytal® Wound Matrix
Warnings, Precautions, Storage, Complications
■ Chronic Wound Management
Cytal® Wound Matrix has been shown to be effective in the treatment of chronic wounds, such as diabetic foot ulcers and venous leg ulcers. These wounds often fail to heal due to underlying conditions like poor blood circulation and chronic inflammation. Cytal® Wound Matrix allows for rapid progression of the wound healing process by providing a scaffold for cellular infiltration and tissue deposition3
■ Acute Wound Healing
Cytal® Wound Matrix can be used in the management of acute wounds such as surgical wounds, traumatic injuries (abrasions, lacerations, second-degree burns, and skin tears), donor sites/ grafts, post-Mohs surgery, post-laser surgery, podiatric, wound dehiscence. Its ability to promote rapid tissue regeneration makes it ideal for situations where quick wound closure is desired.
■ Reconstructive Surgery
In reconstructive surgery, Cytal® Wound Matrix is used to support the healing of soft tissue defects and to facilitate the integration of grafts. It can be used in conjunction with other collagen-based devices, such as Integra’s MicroMatrix® Dermal Repair Powder, to support wound closure in complex reconstructive procedures.
■ Irregular wound beds
In conjunction with Integra’s MicroMatrix® Dermal Repair Powder helps to address contour challenges (e.g. uneven, tunneled, undermined wounds).
■ Exposure to contaminated or infected field can lead to rapid breakdown of device.
■ If active infection is present, treat patient to resolve infection prior to device application.
■ Do not use if cracked, broken, or otherwise damaged.
■ Once package is opened, do not reseal. Delayed use of remnant or resealed material could increase the likelihood of exposure to excess moisture or product contamination, increasing the risk of adverse reaction or infection.
■ Always use aseptic technique when handling device.
■ Complications and reactions are possible with any soft tissue repair, including but not limited to: infection, increased chronic inflammation, allergic reaction, unexplained fever or chills, excessive redness, pain, or swelling.
■ MicroMatrix® Dermal Repair Powder is not indicated for treatment of alopecia.
■ Do not use on patients with known sensitivity or allergy to porcine materials.
■ Do not use on third-degree burns.
■ This device is intended for one-time use.
Figure 3a: Necrotic diabetic ulcer to the medial aspect of the patient's right foot
Figure 3b: Debridement in the operating room down to the joint capsule
Figure 3c: Cytal® Wound Matrix technology secured to wound bed with sutures
Figure 3d: Full-thickness wound healed 13 weeks from the date of surgery
The clinical efficacy of Cytal® Wound Matrix is supported by several studies and case reports, demonstrating its effectiveness in various wound healing and tissue regeneration scenarios.
Inflammatory Response
■ Cytal® Wound Matrix provides an environment where the body is more likely to exhibit a higher ratio of M2 (pro-remodeling) to M1 (proinflammatory) macrophages1,2.
■ In a prospective case control study, wound management with UBM resulted in a statistically significant decrease in M1 to M2 scores for both diabetic (DM) and non-diabetic (non-DM) patients, which correlated with the rate of wound area reduction1,2
■ UBM was associated with wound size reduction in both groups: DM SUBJECTS 35% (±14%) and NONDM SUBJECTS 43% (±18%)1,2
Comprehensive Wound Management
■ Cytal® Wound Matrix offers a wound management solution for different wound sizes or etiologies. In conjunction with Integra’s MicroMatrix® Dermal Repair Powder, it can be used to treat irregular, tunneled, or undermined wounds.
■ Cytal® Wound Matrix offers quick tissue formation to support wound closure by permitting cell infiltration and neovascularization1,4,5,6
Cost
■ Cytal® Wound Matrix provides a cost-effective alternative for the management of complex wounds14
■ Cytal® Wound Matrix allowed for healing of complex wounds at lower costs due to requiring less material and employee hours than NPWT with comparable healing times14
Availability of these products might vary from a given country or region to another, as a result of specific local regulatory approval or clearance requirements for sale in such country or region.
Non contractual document. The manufacturer reserves the right, without prior notice, to modify the products in order to improve their quality. Warning: Applicable laws restrict these products to sale by or on the order of a physician. Consult product labels and inserts for any indications, contraindications, hazards, warnings, precautions, and instructions for use.
Products mentioned in this document are CE class III devices. Please contact Integra customer service should you need any additional information on devices classification. All the medical devices mentioned on this document are CE marked in accordance with the applicable European laws, unless specifically identified as “NOT CE MARKED”.
Integra and the Integra logo are registered trademarks of Integra LifeSciences in the United States and/or other countries. Cytal and MicroMatrix are registered trademarks of Integra LifeSciences Corporation or its subsidiaries.
For more information or to place an order, please contact Sales & Marketing EMEA, Integra LifeSciences Services (France) SAS, Immeuble Séquoia 2 97 allée Alexandre Borodine, Parc technologique de la Porte des Alpes, 69800 Saint Priest FRANCE, Phone: +33 (0)4 37 47 59 00.
■ Cytal® Wound Matrix is a versatile and clinically proven product that can make a difference in wound healing and new tissue deposition. Its collagen-based scaffold supports cellular infiltration, angiogenesis1,4,5,6 and site-appropriate tissue formation1,7-12, making it an effective solution for a wide range of clinical applications.
■ Cytal® Wound Matrix provides an environment where the body is more likely to exhibit a higher ratio of M2 (pro-remodeling) to M1 (proinflammatory) macrophages1,4. A lower M1 to M2 ratio has been associated with constructive tissue remodeling, whereas a higher M1 response is associated with an encapsulation or integration response1,2.
■ The clinical efficacy of Cytal® Wound Matrix is supported by several studies and case reports that demonstrate its effectiveness in various wound healing and tissue regeneration scenarios.
■ Cytal® Wound Matrix is available in multiple layering configurations and sizes with varying resorption profiles that allow for tailored management of a wide variety of wounds.
References
1. Brown BN et al., Acta Biomaterialia. 2012. In animal.
2. Paige JT et al. Regen Med. 2019.
3. Agrawal V et al. Proceedings of the National Academy of Sciences of the USA. 2010. In animal.
4. Sadtler et al, Seminars in Immunology 29 (2017).
5. Song J et al. Journal of Regenerative Medicine and Tissue Engineering. 2014.
6. Remlinger NT et al. Organogenesis. 2013. In animal.
7. Gilbert TW et al, J Surg Res., 2008.
8. Nieponice A et al, Ann Thorac Surg. 2006.
9. Boruch AV et al, J Surg Res. 2010.
10. Agrawal V et al, J Tissue Eng Regen Med. 2009.
