How to Select an Extracellular Matrix for Wound Repair: A Comprehensive Review.

Background: An extracellular matrix (ECM) is a network of proteins and other molecules that provide support and structure to cells and tissues in the body. Since its discovery in 1930, researchers have reproduced the ECM through an array of evolving technologies, developing products that accelerate healing times, minimize scarring, and reduce pain. When selecting which ECM product to use, physicians rely on personal experience while considering wound location, type of tissue lost, exposed structures, chronicity, and even the patient's religious preferences. While comparison trials between a few different types of ECMs exist, there lacks a thorough investigation that assesses a majority of ECMs against each other. Methods: Herein, we conducted a literature review using the PubMed database and utilized 71 articles to identify the best ECM for wound healing and positive patient outcomes. The primary search terms included Results: We compared the indications, advantages, and disadvantages of each ECM and concisely illustrated these findings to provide a guide on how to select an ECM Conclusions: Our findings assist in removing the subjectivity component of selecting an ECM and suggest further comparison or head-to-head trials would yield a more algorithmic approach to wound healing. We suggest to consider implementing the Disabilities of the Arm, Shoulder, and Hand (DASH) score as an additional objective comparison method in these future trials.