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

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

Medicina ◽

10.3390/medicina56010017 ◽

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.

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

The American Surgeon ◽

10.1177/000313481908500953 ◽

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.

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Does Acellular Dermal Matrix Thickness Affect Complication Rate in Tissue Expander Based Breast Reconstruction?

Plastic Surgery International ◽

10.1155/2016/2867097 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6

Author(s):

Jessica F. Rose ◽

Sarosh N. Zafar ◽

Warren A. Ellsworth IV

Keyword(s):

Breast Reconstruction ◽

Skin Necrosis ◽

Tissue Expander ◽

Retrospective Chart Review ◽

Acellular Dermal Matrix ◽

Complication Rates ◽

Dermal Matrix ◽

Drain Removal ◽

Dermal Matrices ◽

Acellular Dermal

Background. While the benefits of using acellular dermal matrices (ADMs) in breast reconstruction are well described, their use has been associated with additional complications. The purpose of this study was to determine if ADM thickness affects complications in breast reconstruction. Methods. A retrospective chart review was performed including all tissue expander based breast reconstructions with AlloDerm (LifeCell, Branchburg, NJ) over 4 years. We evaluated preoperative characteristics and assessed postoperative complications including seroma, hematoma, infection, skin necrosis, and need for reintervention. We reviewed ADM thickness and time to Jackson-Pratt (JP) drain removal. Results. Fifty-five patients underwent 77 ADM-associated tissue expander based breast reconstructions, with average age of 48.1 years and average BMI of 25.9. Average ADM thickness was 1.21 mm. We found higher complication rates in the thick ADM group. Significant associations were found between smokers and skin necrosis (p<0.0001) and seroma and prolonged JP drainage (p=0.0004); radiated reconstructed breasts were more likely to suffer infections (p=0.0085), and elevated BMI is a significant predictor for increased infection rate (p=0.0037). Conclusion. We found a trend toward increased complication rates with thicker ADMs. In the future, larger prospective studies evaluating thickness may provide more information.

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Acellular dermal matrix contributes to epithelialization in patients with chronic sinusitis

Journal of Biomaterials Applications ◽

10.1177/0885328218822636 ◽

2019 ◽

Vol 33 (8) ◽

pp. 1053-1059

Author(s):

Zhong Bing ◽

Liu Feng ◽

Chun-Shu Wu ◽

Jin-Tao Du ◽

Ya-Feng Liu ◽

...

Keyword(s):

Chronic Sinusitis ◽

Acellular Dermal Matrix ◽

Gelatin Sponge ◽

Matrix Group ◽

Control Group ◽

Nasal Surgery ◽

Dermal Matrix ◽

Mucosal Repair ◽

Matrix Groups ◽

Acellular Dermal

Background Nasal endoscopic surgery is widely used for nasal diseases, including sinusitis and tumors. However, scar hyperplasia, nasal irritation, scab, and nasal obstruction delay nasal mucosal recovery, with prolonged cleaning exacerbating the patient's financial burden. Here, we presented a novel approach for the treatment of nasal mucosal defects, termed acellular dermal matrix. Methods A total of 31 patients with bilateral chronic sinusitis (maxillary sinusitis and ethmoid sinusitis) underwent nasal surgery and nasal mucosal repair in September–October 2016. We divided the nasal cavities of each patient into control and acellular dermal matrix groups, randomly selected one side for nasal mucosal repair by surgery. A suitable acellular dermal matrix size was selected according to the defect in each patient. After pruning, the acellular dermal matrix was placed on the wound surface and filled with gelatin sponge. All patients were followed up for 14 weeks to compare nasal mucosal epithelialization between the control and acellular dermal matrix groups. Results：No obvious complications and adverse reactions were observed after nasal surgery. Lund-Kennedy scores in the acellular dermal matrix group were significantly decreased compared with the control group at 8 (0 (0, 1) vs. 2 (2, 4); P<0.05) weeks. Epithelialization time of eight weeks in the acellular dermal matrix groups was significantly decreased than the control group of 14 weeks. Conclusion Acellular dermal matrix provides a growth framework for the healthy mucosa on the wounded surface and reduces postoperative epithelialization time.

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Evaluation of lymphangiogenesis in acellular dermal matrix

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.146578 ◽

2014 ◽

Vol 47 (03) ◽

pp. 318-324 ◽

Cited By ~ 4

Author(s):

Mario Cherubino ◽

Igor Pellegatta ◽

Federico Tamborini ◽

Michele Cerati ◽

Fausto Sessa ◽

...

Keyword(s):

Wound Healing ◽

Endothelial Cells ◽

Cell Invasion ◽

Acellular Dermal Matrix ◽

Wound Contraction ◽

Control Group ◽

Dermal Substitute ◽

Dermal Matrix ◽

Microscopic Evaluation ◽

Acellular Dermal

ABSTRACT Introduction: Much attention has been directed towards understanding the phenomena of angiogenesis and lymphangiogenesis in wound healing. Thanks to the manifold dermal substitute available nowadays, wound treatment has improved greatly. Many studies have been published about angiogenesis and cell invasion in INTEGRA®. On the other hand, the development of the lymphatic network in acellular dermal matrix (ADM) is a more obscure matter. In this article, we aim to characterize the different phases of host cell invasion in ADM. Special attention was given to lymphangiogenic aspects. Materials and Methods: Among 57 rats selected to analyse the role of ADM in lymphangiogenesis, we created four groups. We performed an excision procedure on both thighs of these rats: On the left one we did not perform any action except repairing the borders of the wound; while on the right one we used INTEGRA® implant. The excision biopsy was performed at four different times: First group after 7 days, second after 14 days, third after 21 days and fourth after 28 days. For our microscopic evaluation, we used the classical staining technique of haematoxylin and eosin and a semi-quantitative method in order to evaluate cellularity counts. To assess angiogenesis and lymphangiogenesis development we employed PROX-1 Ab and CD31/PECAM for immunohistochemical analysis. Results: We found remarkable wound contraction in defects that healed by secondary intention while minor wound contraction was observed in defects treated with ADM. At day 7, optical microscopy revealed a more plentiful cellularity in the granulation tissue compared with the dermal regeneration matrix. The immunohistochemical process highlighted vascular and lymphatic cells in both groups. After 14 days a high grade of fibrosis was noticeable in the non-treated group. At day 21, both lymphatic and vascular endothelial cells were better developed in the group with a dermal matrix application. At day 28, lymphatic endothelial cells had organized themselves, engineering the pseudocylindrical structure better disposed in the ADM group than in the control group, and the lymphatic cells were detectable inside the vessels’ lumen in this group. Conclusion: This study has made it possible to demonstrate the absolute importance of an ADM in proper wound healing and has shown better definition of both the qualitative and quantitative aspects of lymphangiogenesis compared to the second intention healing. A major grade of organization of the extracellular matrix and a minor grade of fibrosclerosis in ADM allowed a well-structured morphologic and functional development of the endothelial and lymphatic vascular structures. This study hopes to represent a clinical basis for a wider use of ADM in lesions where lymphatic complications are common.

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The Utility of Novel Fish-Skin Derived Acellular Dermal Matrix (Kerecis) as a Wound Dressing Material

Journal of Wound Management and Research ◽

10.22467/jwmr.2020.01228 ◽

2021 ◽

Vol 17 (1) ◽

pp. 39-47

Author(s):

Tae Hyung Kim ◽

Jun Ho Park ◽

Hyun Gyo Jeong ◽

Syeo Young Wee

Keyword(s):

Wound Healing ◽

Healing Rate ◽

Computer Software ◽

Acellular Dermal Matrix ◽

Control Group ◽

Omega 3 ◽

Dermal Matrix ◽

Burn Wounds ◽

Novel Material ◽

Acellular Dermal

Background: The newly-approved Kerecis is a piscine acellular dermal xenograft. This piscine acellular dermal matrix (ADM) has specific bioactive lipid mediators, omega-3 polyunsaturated fatty acids, and has a positive effect on the process of wound healing. This study aimed to explore the utility of this novel material by comparing healing rates, and suggest the proper timing for applying Kerecis.<br/>Methods: Patients who visited the hospital with acute or chronic deep dermal wounds from June 2019 to May 2020 were enrolled in the study. A total of 48 patients were assessed. All wounds in the experimental group (n=16) were treated only once with Kerecis and a non-adherent absorptive foam material (Therasorb) to cover the ADM. In the control group, daily conventional dressings were provided. All wounds sizes were measured with mass-market computer software in a method suggested by the authors for the first time.<br/>Results: The mean healing rate proved to be faster in the Kerecis group (P<0.05) versus the control group, and no complications were observed. It was statistically proved that treating burn wounds with the ADM showed better healing rates than the conventional method (P<0.05).<br/>Conclusion: This study establishes that managing wounds with the ADM is likely to heal wounds faster than traditional dressings. In addition, for burn wounds, a prolonged application (10 days vs. 5 days after the onset) showed a better wound healing rate (98.8%±2.5% vs. 67.0%±14.3%, respectively, P=0.029).

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

Acta Odontológica Latinoamericana ◽

10.54589/aol.34/2/136 ◽

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.

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Clinical and Histological Differences between Guided Tissue Regeneration with Acellular Dermal Matrix of Porcine Origin and Autologous Connective Tissue: An Animal Study

Materials ◽

10.3390/ma14020272 ◽

2021 ◽

Vol 14 (2) ◽

pp. 272

Author(s):

Javier Aragoneses ◽

Ana Suárez ◽

Cinthia Rodríguez ◽

Juan Manuel Aragoneses

Keyword(s):

Connective Tissue ◽

Acellular Dermal Matrix ◽

Control Group ◽

Dermal Matrix ◽

A Value ◽

Keratinized Tissue ◽

Sus Scrofa Domestica ◽

Acellular Dermal ◽

Porcine Origin ◽

Keratin Layer

This research aims to evaluate the clinical and histological parametric differences concerning keratinized tissue that result from two regeneration techniques, the subepithelial autologous connective tissue graft (ACTG) and the acellular dermal matrix (MD) of porcine origin, performed on surgical beds on edentulous spaces in an animal model. The parameters of the MD and ACTG groups were compared with samples of the control group (CG) after 15, 45, and 90 days. Nine female white pigs (Sus scrofa domestica) were used, and each animal provided 20 study areas (12 MD and 8 ACTG). At 15 days, the keratin layer thickness in the MD group was greater than those of the ACTG (25.27 vs. 19.95 μm) and the CG (21.2 μm). After 45 days, the MD and ACTG thickness values decreased but were higher than the CG. At 90 days, MD (19.46 μm) obtained a value close to that of CG, and the ACTG decreased to CG (15.53 μm, p < 0.001). The use of an MD may be a viable alternative to the ACTG because of its ability to provide increased keratinized tissue in comparison to the ACTG.

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

Journal of Medical Case Reports ◽

10.1186/s13256-021-02787-5 ◽

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.

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Implant-based immediate reconstruction in prophylactic mastectomy: is the caudal dermis flap a reliable alternative to synthetic mesh or acellular dermal matrix?

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06244-y ◽

2021 ◽

Author(s):

N. Heine ◽

V. Hoesl ◽

S. Seitz ◽

L. Prantl ◽

V. Brebant

Keyword(s):

Health Care Professionals ◽

Skin Necrosis ◽

Prophylactic Mastectomy ◽

Tissue Expander ◽

Acellular Dermal Matrix ◽

Synthetic Mesh ◽

Immediate Reconstruction ◽

Dermal Matrix ◽

Excess Skin ◽

Acellular Dermal

Abstract Introduction The demand for prophylactic mastectomy has increased significantly over the last 10 years. This can be explained by a substantial gain of knowledge about the clinical risk and outcome of patients with high risk mutations such as BRCA1 and 2, the improved diagnostic possibilities for detecting the genetic predisposition for the development of breast cancer and the awareness for those mutations by health care professionals as well as patients. In addition to expander-to-implant reconstruction and microsurgical flap surgery, definitive immediate reconstruction with subpectoral insertion of breast implants is often preferred. The prosthesis is covered at its inferior pole by a synthetic mesh or acellular dermal matrix. In these cases, in addition to the silicone prosthesis, a further foreign body must be implanted. This can be exposed in the event of wound healing disorder or necrosis of the usually thin soft tissue covering after subcutaneous mastectomy, thus calling into question the reconstructive result. In this study, the coverage of the lower pole by a caudal deepithelialized dermis flap, which allows the implant to be completely covered with well vascularized tissue, is compared to coverage by a synthetic mesh or acellular dermal matrix. Patients and methods From January 2014 to June 2020, 74 patients (106 breasts) underwent breast reconstruction following uni or bilateral prophylactic mastectomy. Reconstruction was performed with autologous tissue (15 breasts), with tissue expander or implant without implant support (15 breasts), with implant and use of an acellular dermal matrix or synthetic mesh (39 breasts) and with implant and caudal dermis flap (37 breasts). In this study, we compared the patients with implant and dermal matrix/mesh to the group reconstructed with implant and dermal flap. Results In the group with the caudal dermis flap, 4 patients developed skin necrosis, which all healed conservatively due to the sufficient blood supply through the dermis flap. In the group with the use of a synthetic mesh or acellular dermal matrix, skin necrosis was found in three cases. In one of these patients the implant was exposed and had to be removed. Discussion For patients with excess skin or macromastia, the caudal dermis flap is a reliable and less expensive option for complete coverage of an implant after prophylactic mastectomy. In particular, the vascularized dermis flap can protect the implant from the consequences of skin necrosis after prophylactic mastectomy.

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