Introduction

The extracellular matrix (ECM) is a critical component of tissue architecture and repair. Composed of proteins, glycoproteins, and polysaccharides, the ECM provides structural scaffolding and biochemical signals essential to cell behavior. In chronic wounds, ECM degradation or dysfunction is often a barrier to healing, prompting the development of biologic wound care products that aim to restore or mimic ECM function.

This article reviews the role of the extracellular matrix in wound healing and its implications for the use of advanced biologic dressings.

What Is the Extracellular Matrix?

The ECM is a complex, three-dimensional network that supports cells and regulates intercellular communication. Key components include:

In healthy skin, the ECM maintains homeostasis and supports rapid tissue turnover. During wound healing, it orchestrates cellular responses across the inflammatory, proliferative, and remodeling phases.

ECM Dysfunction in Chronic Wounds

In chronic wounds, the ECM is often fragmented, enzymatically degraded, or chemically altered by prolonged inflammation. This dysfunctional matrix impairs the recruitment and activity of key reparative cells, such as fibroblasts and keratinocytes, and disrupts the availability of growth factors.

Excess matrix metalloproteinases (MMPs) and insufficient tissue inhibitors of metalloproteinases (TIMPs) are commonly observed, leading to unregulated ECM breakdown. As a result, the wound remains stalled in the inflammatory phase, unable to progress to tissue regeneration.

Biologic Products That Address ECM Deficiency

Advanced biologic dressings are designed to replace or supplement ECM function. These include:

These products are processed to retain ECM integrity while removing cellular elements to minimize immunogenicity. When applied to a prepared wound bed, they may support re-epithelialization and granulation by restoring the scaffold and signaling environment.

Considerations for Providers

When selecting ECM-based biologic products for wound care, clinicians should evaluate:

Application technique, frequency, and compatibility with other wound care modalities also influence clinical decisions. Products regulated under FDA 21 CFR Part 1271 must meet criteria for homologous use and minimal manipulation.

Summary for Providers

The extracellular matrix is central to wound healing, and its degradation is a hallmark of chronic, non-healing wounds. Biologic dressings that restore ECM structure and function represent a targeted approach in advanced wound management.

By understanding ECM dynamics, providers can better align product selection with the wound’s physiologic needs, supporting a more conducive environment for tissue repair and progression through the healing cascade.

References

1. Schultz GS, Davidson JM, Kirsner RS, Bornstein P, Herman IM. Dynamic reciprocity in the wound microenvironment. Wound Repair Regen. 2011;19(2):134–148.
2. Nunan R, Harding KG, Martin P. Clinical challenges of chronic wounds: searching for an optimal animal model to recapitulate their complexity. Dis Model Mech. 2014;7(11):1205–1213.
3. U.S. Food and Drug Administration. Human Cells, Tissues, and Cellular and Tissue-Based Products (HCT/Ps)