Acellular dermal matrix reconstruction of a nail bed avulsion in a 13-year-old child

2020 ◽  
Vol 13 (9) ◽  
pp. e236253
Author(s):  
Ailbhe L Kiely ◽  
Lilli RL Cooper ◽  
Aina Greig
Keyword(s):  
Donor Site ◽  
Acellular Dermal Matrix ◽  
Distal Phalanx ◽  
Dermal Matrix ◽  
No Donor ◽  
Nail Bed ◽  
Matrix Reconstruction ◽  
History Of ◽  
One Step ◽  
Acellular Dermal

Nail bed avulsion injuries often require reconstruction, particularly in cases where the avulsed fragment is lost. We describe a simple way to reconstruct a large nail bed defect, with no donor site. A 13-year-old boy with a hypoplastic left heart and autism accidentally sustained a left little distal phalanx injury with an avulsion of 60% of the nail bed, exposing the distal phalanx. This boy had a history of poor compliance, qualifying the need to find a technique that would minimise operative time and dressing changes. As such, it was elected to use an acellular dermal matrix (ADM) (Matriderm) as a one-step reconstruction. Signs of vascularisation of the ADM were noted at 2 weeks, and 3-month follow-up demonstrated integration, with normal nail growth. We found that Matriderm was able to support the regeneration of a full thickness wound in a simple one-step procedure.

scholarly journals Reconstruction for Defects of Total Nail Bed and Germinal Matrix Loss with Acellular Dermal Matrix Coverage and Subsequently Skin Graft

Medicina ◽  
2020 ◽  
Vol 56 (1) ◽  
pp. 17
Author(s):  
Tsung-Hsien Liu ◽  
Meng-Chien Hsieh ◽  
Ping-Ruey Chou ◽  
Shu-Hung Huang
Keyword(s):  
Skin Graft ◽  
Donor Site ◽  
Acellular Dermal Matrix ◽  
Dermal Matrix ◽  
Germinal Matrix ◽  
Nail Bed ◽  
Staged Operation ◽  
Matrix Loss ◽  
Bone Exposure ◽  
Acellular Dermal

Background and Objectives: Nail bed and germinal matrix loss due to wide excision for fingertip tumors or malignancy are occasionally encountered complications. These defects also result from severely comminuted fingertip crush injuries. Large-area dorsal finger or toenail bed defects, which usually present with phalangeal bone exposure, remain challenging regardless of the usage of different reconstruction strategies. This study aimed to evaluate the clinical outcome of a staged operation with an acellular dermal matrix coverage and subsequent skin graft as reconstruction for defects of total nail bed, germinal matrix loss, and bone exposure. Materials and Methods: From April 2018 to October 2019, four patients with total nail bed, germinal matrix, and bone exposure loss after surgery were enrolled in our series. A staged operation of the acellular dermal matrix coverage with subsequent skin graft was performed on these patients. Skin graft take rate, oncological prognosis, and cosmetic outcome were evaluated. Patients were followed up for 5–13 months. An excellent skin graft take rate with a satisfying aesthetic result without local malignancy recurrence was noted. Minimal functional deficit and donor site morbidity were reported. Results: A staged operation with acellular dermal matrix coverage and subsequent skin graft proves to serve as a feasible strategy for patients who experience total nail bed, germinal matrix loss, and bone exposure after surgery. Conclusions: This reconstruction method provides a reliable repair result, satisfying aesthetic outcomes, as well as having minimal functional deficits and donor site morbidity.

scholarly journals Role of a new acellular dermal matrix in a multistep combined treatment of dermatofibrosarcoma protuberans of the lumbar region: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Fedele Lembo ◽  
Liberato Roberto Cecchino ◽  
Domenico Parisi ◽  
Aurelio Portincasa
Keyword(s):  
Negative Pressure Wound Therapy ◽  
Donor Site ◽  
Acellular Dermal Matrix ◽  
Dermatofibrosarcoma Protuberans ◽  
Donor Site Morbidity ◽  
Lumbar Region ◽  
Dermal Matrix ◽  
Alternative Approach ◽  
History Of ◽  
Acellular Dermal

Abstract Background Dermatofibrosarcoma protuberans (DFSP) is a rare skin fibroblastic tumor, with a high rate of recurrence. The treatment of DFSP is generally surgical, and wide local excision is the mainstay of surgical treatment. Therefore, complete assessment of all surgical margins is fundamental before definitive reconstruction. The reconstruction is a challenge for plastic surgeons, especially in particular anatomical areas (for aesthetic or functional problems) or in patients who are not candidates for more complex surgical treatments. We describe an alternative approach for reconstructive treatment of the lumbar area after wide excision of DFSP (without fresh-frozen sections) in a young obese woman with a history of smoking, using a new type of acellular dermal matrix (ADM) in a combined management protocol. The benefits of ADM are numerous: immediate wound closure and prevention of infections and excessive drying; minimal donor site morbidity; and good functional and aesthetic outcomes. Moreover, it is a temporary cover while the anatomical specimen is histologically analyzed, without donor site morbidity or prevention of any future surgery (if the margins are not tumor-free) or radiotherapy. Case presentation In October 2019, a 34-year old obese Caucasian Woman with a history of smoking came to our institute for a multinodular growing polypoid mass in her lumbar region. An incisional biopsy diagnosed DFSP. The patient underwent proper staging. A wide local excision with 3 cm clinically healthy tissue margins down to the muscle fascia was performed and the defect was repaired using a combined approach with a new artificial bilaminar dermal template (Pelnac®, Gunze Ltd., Osaka, Japan) and a negative-pressure wound therapy system (V.A.C.®, KCI, San Antonio, USA). After the final histological examination revealed tumor-free margins, a split-thickness graft was harvested from the right gluteus and fixed to the new derma with negative-pressure wound therapy. Postoperative radiotherapy was not necessary. After 15 days, the wound had healed without complications, with satisfactory aesthetic outcome and with no limitation of back motion or pain. After 6 months of follow-up, the patient was free from disease. Conclusions This is the first reported case of Pelnac® use in DFSP reconstruction of the lumbar region. We believe that the multistep approach described herein may be a good alternative approach in selected patients with wide resections in particular anatomical areas, especially when frozen sections (with Mohs micrographic surgery) are not available.

Human Acellular Dermal Matrix is a Viable Alternative to Autologous Skin Graft in Patients with Cutaneous Malignancy

2019 ◽  
Vol 85 (9) ◽  
pp. 1056-1060
Author(s):  
Rachel E. Lewis ◽  
Emily A. Towery ◽  
Sneha G. Bhat ◽  
Andrew J. Ward ◽  
Robert E. Heidel ◽  
...  
Keyword(s):  
Skin Cancer ◽  
Cell Carcinoma ◽  
Donor Site ◽  
Acellular Dermal Matrix ◽  
Healing Time ◽  
Viable Alternative ◽  
Skin Substitutes ◽  
Dermal Matrix ◽  
Acellular Dermal ◽  
Human Acellular Dermal Matrix

Skin substitutes have shown success in complex wound reconstruction. We evaluate the use of a human acellular dermal matrix (ADM) as a viable alternative to autologous skin grafting for defects secondary to skin cancer excision. An institutional review board–approved, retrospective review of ADM-reconstructed defects secondary to skin cancer excision between 2012 and 2018 was conducted. ADM was indicated in patients with preclusive factors for general anesthesia, protracted procedure time, reluctance for additional donor site wound, and personal choice. We reviewed defect characteristics, healing time, postoperative outcomes, and patient demographics. The 228 participants (151 males, 77 females) had a median age of 72 years (range, 29–95 years), with melanoma diagnosed in 113 (49.6%), squamous cell carcinoma in 61 (26.8%), and basal cell carcinoma in 28 (12.2%) patients. The median interval to complete epidermal coverage was 42 days, with graft failure evident in six patients (2.6%). ADM is a viable, low-morbid alternative for reconstruction of defects secondary to skin cancer excision, with no donor site morbidity. With exception to complete healing time, outcomes are similar to those of autologous grafting.

DermACELL: Human Acellular Dermal Matrix Allograft

2016 ◽  
Vol 106 (2) ◽  
pp. 133-137 ◽  
Author(s):  
Windy E. Cole
Keyword(s):  
Wound Care ◽  
Care Center ◽  
Acellular Dermal Matrix ◽  
Diabetic Woman ◽  
Diabetic Patients ◽  
Dermal Matrix ◽  
Antibiotic Drug ◽  
History Of ◽  
Acellular Dermal ◽  
Human Acellular Dermal Matrix

Diabetes often causes ulcers on the feet of diabetic patients. A 56-year-old, insulin-dependent, diabetic woman presented to the wound care center with a Wagner grade 3 ulcer of the right heel. She reported a 3-week history of ulceration with moderate drainage and odor and had a history of ulceration and osteomyelitis in the contralateral limb. Rigorous wound care, including hospitalization; surgical incision and drainage; intravenous antibiotic drug therapy; vacuum-assisted therapy; and a new room temperature, sterile, human acellular dermal matrix graft were used to heal the wound, save her limb, and restore her activities of daily living. This case presentation involves alternative treatment of a diabetic foot ulcer with this new acellular dermal matrix, DermACELL.

scholarly journals Clinical evaluation of root coverage using coronally positioned flap associated with acellular dermal matrix allograft in single-type recession defects. A retrospective study

2021 ◽  
Vol 34 (2) ◽  
pp. 136-142
Author(s):  
Guillermo Schinini ◽  
Alessia Molinari ◽  
Hugo Romanelli
Keyword(s):  
Retrospective Study ◽  
Donor Site ◽  
Acellular Dermal Matrix ◽  
Single Type ◽  
Root Coverage ◽  
Dermal Matrix ◽  
Keratinized Tissue ◽  
Probing Depth ◽  
Clinical Records ◽  
Acellular Dermal

The aim of this study was to conduct a retrospective assessment of the clinical results at 6,12 and 24 months of root coverage in single gingival recessions using coronally positioned flap and acellular dermal matrix allograft. Clinical records were collected from 16 patients with single gingival recessions who visited a private practice in Periodontics in 2005 and 2006. They were treated through a coronally positioned flap and acellular dermal matrix allograft. The following periodontal parameters were recorded at baseline, 6, 12 and 24 months: Recession Depth, Recession Width, Probing Depth, Clinical Attachment Level, Keratinized Tissue Width, Plaque Index, Gingival Index and Sensitivity. The percentage of root coverage was 91.18 ± 21.26 at 6 months, 90.18 ± 22.04 at 12 months and 90.83 ± 18.41 at 24 months. Complete root coverage was 81% (13 out of 16) at 6 and 12 months. At 24 months, complete root coverage was 75% (9 out of 12). The plaque and gingival indexes did not vary significantly between baseline and measurement times. Probing depth was maintained at healthy levels during the months of follow-up. Sensitivity decreased at 12 months (4 of 16) compared to baseline (14 of 16), and was maintained at 2 years (2 of 12). This retrospective study showed that acellular dermal matrix allograft could be considered a useful alternative for the treatment of single gingival recessions, reducing the discomfort and morbidity associated with the palatal donor site.

Threatened ventriculostomy shunt exposure: augmenting native soft tissue coverage with acellular dermal matrix graft

2012 ◽  
Vol 10 (4) ◽  
pp. 324-326
Author(s):  
Thomas Ridder ◽  
Shuhao Zhang ◽  
Gary Tye ◽  
Jennifer L. Rhodes
Keyword(s):  
Soft Tissue ◽  
Pediatric Population ◽  
Case Series ◽  
Acellular Dermal Matrix ◽  
Soft Tissue Augmentation ◽  
Shunt Revision ◽  
Soft Tissue Coverage ◽  
Dermal Matrix ◽  
History Of ◽  
Acellular Dermal

Avoiding threatened ventriculostomy shunt exposure in the pediatric population remains a difficult problem for the neurosurgeon and reconstructive surgeon. In this case series, the authors present a novel method of augmenting scalp soft tissue with acellular dermal matrix (ADM) in patients with a history of ventricular shunt revisions. Soft tissue augmentation with ADM successfully prevented shunt exposure in 3 patients with a history of shunt revision due to impending exposure following conventional techniques.

Acellular Dermal Matrix Reconstruction of the Head and Neck: A Versatile Reconstructive Option

2011 ◽  
Vol 145 (2_suppl) ◽  
pp. P160-P160
Author(s):  
Joshua R. Mitchell ◽  
Jamie Robinson ◽  
Sanjeet Rangarajan ◽  
Sravan Dhulipala ◽  
James L. Netterville ◽  
...  
Keyword(s):  
Head And Neck ◽  
Acellular Dermal Matrix ◽  
Dermal Matrix ◽  
Matrix Reconstruction ◽  
Reconstructive Option ◽  
Acellular Dermal

scholarly journals Acellular dermal matrix used after large surgical ressection in ameloblastoma with buccal mucosa extension: a case report

2021 ◽  
Vol 10 (13) ◽  
pp. e564101321634
Author(s):  
Humberto Jácome-Santos ◽  
Fernanda Luiza Araújo de Lima Castro ◽  
Renata Gonçalves Resende ◽  
Renata de Carvalho Lacerda ◽  
Aline Fernanda Cruz ◽  
...  
Keyword(s):  
Oral Cavity ◽  
Buccal Mucosa ◽  
Inflammatory Diseases ◽  
Donor Site ◽  
Tumor Resection ◽  
Acellular Dermal Matrix ◽  
Donor Site Morbidity ◽  
Dermal Substitute ◽  
Dermal Matrix ◽  
Acellular Dermal

Neoplastic, traumatic, and inflammatory diseases of the oral cavity and oropharynx frequently result in significant defects after resection, also, they may present challenge reconstruction. Regional and distant flaps such as skin grafts (SGs) are routinely used to cover mucosal defects arising from large resections, to restore tissue volume and preserve function. However, there are some disadvantages, mainly related to the donor site morbidity, including pain, risk of infection, occasional hypertrophic scar, and additional contracture resulting from a relative lack of dermis. Therefore, acellular dermal membrane (ADM) seems to be an applicable option to avoid those issues, and it has been shown good results for covering tissue defects. Thus, this study reports the first experience of using the double-layer dermal substitute (DLDS) (NeveliaÒ made by Symatese, France) in oral cavity, to cover and repair a buccal defect, immediately after a large resection of ameloblastoma extending to buccal mucosa. After surgical intervention and actually in follow-up, the patient shows good aesthetic and functional status, 24 months postoperatively. Thus, this DLDS seems to be a good resource in primary buccal reconstruction after extensive tumor resection. However, more studies are needed to be performed.

Qualitative and Quantitative Analyses of Donor Site Morbidity Following a Graft of the Acellular Dermal Matrix Versus Primary Fascial Repair After ALT Flap Harvesting

2020 ◽  
pp. 229255032093369
Author(s):  
Sun Je Kim ◽  
Heesang Yang ◽  
Chungmin Shin ◽  
Youngwoong Choi ◽  
Sang-Ha Oh
Keyword(s):  
Skin Necrosis ◽  
Primary Repair ◽  
Donor Site ◽  
Acellular Dermal Matrix ◽  
Control Group ◽  
Dermal Matrix ◽  
Artificial Dermis ◽  
Ambulatory Ability ◽  
Acellular Dermal ◽  
Alt Flap

Background: The anterolateral thigh (ALT) flap is one of the most useful flaps in reconstruction because of its reliability, large skin flap territory, and versatility. The relatively small number of side effects is a common reason for preferring this flap. Primary repair is usually performed at the donor site closure; however, this requires substantial tension and causes many donor site morbidities, including pain. We attempted to use acellular dermal matrix graft to overcome these problems. Methods: We analyzed a total of 41 cases (41 flaps) in this study. Among these flaps, we conducted donor fascia suture with artificial dermis in 20 cases (study group) and primary fascial suture in 21cases (control group). Post-operative ambulation recovery times, pain scores, drainage removals, and wound problems of the donor site were recorded. Results: There were no serious complications, including infection, at the donor sites of all 41 cases. Of 20 cases using the acellular dermal matrix, seroma occurred in 2 cases and partial skin necrosis occurred in 2 cases. In 1 case of skin necrosis, the acellular dermal matrix was removed. However, in comparison to the control group, the group using the artificial dermis recovered ambulatory ability 3.9 days earlier and had a 1.8-point lower visual analogue scale score 5 days post-operatively. Conclusions: Our study suggested that, if used selectively, the acellular dermal matrix may play an effective role in donor site closure in cases with procedures involving the ALT flap.

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