{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:31:32Z","timestamp":1791347492909,"version":"4.3.1"},"reference-count":38,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T00:00:00Z","timestamp":1766016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Victor Babes University of Medicine and Pharmacy, Timi\u0219oara"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JFB"],"abstract":"<jats:p>Acellular dermal matrices (ADMs) are widely used in soft-tissue reconstruction, yet the optimal timing for split-thickness skin grafting (STSG) remains unsettled. We conducted a single-center retrospective cohort study (January 2023\u2013August 2025) of adults undergoing ADM-based reconstruction with Integra\u00ae Double Layer (IDL), Integra\u00ae Single Layer (ISL), or Nevelia\u00ae. Primary endpoints included length of stay (LOS), STSG requirement and timing, and in-hospital complications; secondary endpoints included spontaneous epithelialization. Prespecified adjusted analyses (linear\/logistic models) controlled for age, sex, etiology, anatomical site, diabetes\/PAOD, smoking, wound size (when available), wound contamination, and matrix type. Histology and immunohistochemistry (H&amp;E, Masson trichrome, CD105, D2-40) assessed matrix integration and vascular\/lymphatic maturation. Seventy-five patients were included (IDL n = 40; ISL n = 20; Nevelia n = 15). On multivariable analysis, matrix type was not an independent predictor of LOS (ISL vs. IDL \u03b2 = +2.84 days, 95% CI \u221217.34 to +23.02; Nevelia vs. IDL \u03b2 = \u22124.49 days, 95% CI \u221216.24 to +7.26). Complications were infrequent (6\/75, 8.0%) and comparable across matrices; spontaneous epithelialization occurred in 3\/75 patients (4.0%). A day-14 grafting strategy, applied only after documented clinical integration, was feasible in 30\/75 (40.0%) patients without excess complications. Histology\/IHC at 3\u20134 weeks demonstrated CD105-positive, perfused capillary networks with abundant collagen; at 4\u20136 weeks, D2-40-positive lymphatic structures confirmed progressive neo-dermis maturation, supporting the biological plausibility of earlier grafting once integration criteria are met. In this cohort, outcomes were broadly similar across matrices after adjustment. A criteria-based early STSG approach (~day 14) appears safe and operationally advantageous when integration is confirmed, while a minority of defects may heal without grafting. Prospective multicenter studies with standardized scar\/functional measures and cost analyses are needed to refine patient selection and graft timing strategies.<\/jats:p>","DOI":"10.3390\/jfb16120469","type":"journal-article","created":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T13:45:07Z","timestamp":1766065507000},"page":"469","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Neo-Dermis Formation and Graft Timing After ADM Reconstruction: A Cohort Study with Histological Validation"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-3386-8468","authenticated-orcid":false,"given":"Daniel","family":"Pit","sequence":"first","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Discipline of Clinical Skills, Department I Nursing, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Burn Unit, Plastic and Reconstructive Surgery Department, Casa Austria, \u201cPius Brinzeu\u201d Emergency County Clinical Hospital, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7753-7621","authenticated-orcid":false,"given":"Teodora","family":"Hoinoiu","sequence":"additional","affiliation":[{"name":"Discipline of Clinical Skills, Department I Nursing, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Burn Unit, Plastic and Reconstructive Surgery Department, Casa Austria, \u201cPius Brinzeu\u201d Emergency County Clinical Hospital, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5217-7655","authenticated-orcid":false,"given":"Bogdan","family":"Hoinoiu","sequence":"additional","affiliation":[{"name":"Department of Oral Rehabilitation and Dental Emergencies, Faculty of Dentistry, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Interdisciplinary Research Center for Dental Medical Research, Lasers and Innovative Technologies, Revolutiei 1989 Avenue No. 9, 300070 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2421-0137","authenticated-orcid":false,"given":"Cristian","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department of Microscopic Morphology\/Histology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Angiogenesis Research Centre, \u201cVictor Babes\u201d University of Medicine and Pharmacy, 300041 Timisoara, Romania"},{"name":"Pathology Department, \u201cPius Brinzeu\u201d Emergency County Clinical Hospital Timisoara, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panche","family":"Taskov","sequence":"additional","affiliation":[{"name":"Doctoral School, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Burn Unit, Plastic and Reconstructive Surgery Department, Casa Austria, \u201cPius Brinzeu\u201d Emergency County Clinical Hospital, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2880-7485","authenticated-orcid":false,"given":"Zorin Petrisor","family":"Crainiceanu","sequence":"additional","affiliation":[{"name":"Burn Unit, Plastic and Reconstructive Surgery Department, Casa Austria, \u201cPius Brinzeu\u201d Emergency County Clinical Hospital, 300723 Timisoara, Romania"},{"name":"Plastic Surgery Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8868-8118","authenticated-orcid":false,"given":"Daciana","family":"Grujic","sequence":"additional","affiliation":[{"name":"Burn Unit, Plastic and Reconstructive Surgery Department, Casa Austria, \u201cPius Brinzeu\u201d Emergency County Clinical Hospital, 300723 Timisoara, Romania"},{"name":"Plastic Surgery Department, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7627-9143","authenticated-orcid":false,"given":"Isabela","family":"Caizer-Gaitan","sequence":"additional","affiliation":[{"name":"Discipline of Clinical Skills, Department I Nursing, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Burn Unit, Plastic and Reconstructive Surgery Department, Casa Austria, \u201cPius Brinzeu\u201d Emergency County Clinical Hospital, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5358-882X","authenticated-orcid":false,"given":"Miruna","family":"Samfireag","sequence":"additional","affiliation":[{"name":"Discipline of Clinical Skills, Department I Nursing, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Center for Advanced Research in Cardiovascular Pathology and Hemostaseology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Burn Unit, Plastic and Reconstructive Surgery Department, Casa Austria, \u201cPius Brinzeu\u201d Emergency County Clinical Hospital, 300723 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6378-4418","authenticated-orcid":false,"given":"Oana","family":"Suciu","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Physical Medicine and Rheumatology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8288-5468","authenticated-orcid":false,"given":"Razvan","family":"Bardan","sequence":"additional","affiliation":[{"name":"Department of Urology, \u201cVictor Babes\u201d University of Medicine and Pharmacy, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Iacomino, E., Fratini, C., Sollima, L., Eibenstein, A., Barbato, C., de Vincentiis, M., Minni, A., and Zoccali, F. (2024). Surgical Resection and Immediate Reconstruction with a Bilayer Wound Collagen Matrix of a Rare Oral Angiosarcoma: A Case Report. Diseases, 12.","DOI":"10.3390\/diseases12060117"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1097\/00000658-198809000-00008","article-title":"Artificial dermis for major burns. A multi-center randomized clinical trial","volume":"208","author":"Heimbach","year":"1988","journal-title":"Ann. 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Open"}],"container-title":["Journal of Functional Biomaterials"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-4983\/16\/12\/469\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T14:01:00Z","timestamp":1766066460000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-4983\/16\/12\/469"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,18]]},"references-count":38,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jfb16120469"],"URL":"https:\/\/doi.org\/10.3390\/jfb16120469","relation":{},"ISSN":["2079-4983"],"issn-type":[{"value":"2079-4983","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,18]]}}}