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Tognetti L, Pianigiani E, Ierardi F, Lorenzini G, Casella D, Liso FG, De Pascalis A, Cinotti E, Rubegni P. The use of human acellular dermal matrices in advanced wound healing and surgical procedures: State of the art. Dermatol Ther 2021; 34:e14987. [PMID: 33993627 DOI: 10.1111/dth.14987] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022]
Abstract
Wound closure after post-traumatic injuries and/or localized at peculiar body sites (head-and-neck, oral cavity, legs) are particularly challenging and can often be delayed due to local and systemic factors. In case of deep wounds and/or hard-to-heal wounds, grafting of dermal acellular matrices (ADM) is often needed. Though a great variety of synthetic and semisynthetic dermal and skin equivalents are available, viable human dermis, is still considered the most physiological alternative to replace the loss of autologous dermis, by acting as a physiological scaffold that add structural support to soft tissues. To date, human ADMs (hADMs) have been employed in the reconstruction of skin defects affecting almost all body sites, ranging from visceral sites to the skin and subcutaneous tissues. This review aims to investigate the use of hADM at different body sites and their peculiar advantages. A literature search was using the search terms "acellular dermal matrices", "dermal regeneration", "advances wound healing", "human acellular dermal matrices surgery". A total of 50 out of 150 papers was included. Based on the current body if evidence, hADMs appear to bring several advantages, such as: protection of deep structures (eg, tendons, bones, cartilage and nerves); stimulation of a functional new dermis (rather than a scar); reduction of wound closure time; control of pain and exudate. Finally, hADMs may represent the best treatment option for hard-to-heal wound not only in terms of efficacy and patient satisfaction bout also in terms of sanitary costs, especially across Europe, where hADMs cannot be commercialized as medical devices.
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Affiliation(s)
- Linda Tognetti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Elisa Pianigiani
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Francesca Ierardi
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Guido Lorenzini
- Department of Odontostomatologic and Ophthalmologic Sciences, University of Siena, Siena, Italy
| | - Donato Casella
- Department of Breast Cancer Surgery, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Flavio Giulio Liso
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Andrea De Pascalis
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
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Tork S, Jefferson RC, Janis JE. Acellular Dermal Matrices: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:173-184. [PMID: 31384233 DOI: 10.1055/s-0039-1693019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Modern advances in tissue engineering have transformed the plastic surgeon's management strategies across a wide variety of applications. Comprehension of the fundamentals of biologic constructs is critical to navigating the available armamentarium. It is essential that plastic surgeons become familiar with some of the existing methods for utilizing biologics as well as the advantages and limitations to their use. In this article, the authors describe the basic science of biologics with a focus on acellular dermal matrices (ADMs), and review the recent evidence behind their use for a variety of reconstructive and aesthetic purposes. The review is organized by system and examines the common indications, techniques, and outcomes pertaining to the application of ADMs in select anatomic areas. The final section briefly considers possible future directions for using biologics in plastic and reconstructive surgery.
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Affiliation(s)
- Shahryar Tork
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Ryan C Jefferson
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey E Janis
- Department of Plastic Surgery, University Hospitals, Wexner Medical Center, Ohio State University, Columbus, Ohio
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Bing Z, Feng L, Wu CS, Du JT, Liu YF, Liu SX. Acellular dermal matrix contributes to epithelialization in patients with chronic sinusitis. J Biomater Appl 2019; 33:1053-1059. [PMID: 30651053 DOI: 10.1177/0885328218822636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
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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Affiliation(s)
- Zhong Bing
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Liu Feng
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Chun-Shu Wu
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Jin-Tao Du
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Ya-Feng Liu
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
| | - Shi-Xi Liu
- Sichuan University, West China Hospital, Department of Otolaryngology Head and Neck Surgery, Chengdu, Sichuan, China
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Privitera A, Dozois EJ. A novel approach to management of a sacral defect in ileal pouch-sacral fistula. J Surg Case Rep 2012; 2012:rjs006. [PMID: 24968393 PMCID: PMC3853803 DOI: 10.1093/jscr/rjs006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Fistula formation after restorative proctocolectomy poses a challenge to the surgeon and sometimes can lead to the excision of the pouch. While pouch-vaginal fistulas are more common, pouch-sacral fistulas are a rare event and treatment is still controversial. The authors report a case of pouch-sacral fistula which was treated successfully with a novel approach comprising pouch revision, debridement of sacrum and placement of a human acellular dermal matrix (Alloderm) mesh to patch the residual large sacral defect. This is the first report of the use of Alloderm under this rare condition.
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Affiliation(s)
- Antonio Privitera
- Department of Surgery, University Hospital of North Staffordshire, Stoke-On-Trent, Staffordshire, UK
| | - Eric J Dozois
- Department of Colon and Rectal Surgery, Mayo Clinic College of Medicine, Rochester, USA
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Dasenbrock HH, Clarke MJ, Bydon A, Witham TF, Sciubba DM, Simmons OP, Gokaslan ZL, Wolinsky JP. Reconstruction of Extensive Defects From Posterior En Bloc Resection of Sacral Tumors With Human Acellular Dermal Matrix and Gluteus Maximus Myocutaneous Flaps. Neurosurgery 2011; 69:1240-7. [DOI: 10.1227/neu.0b013e3182267a92] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Han JG, Wang ZJ, Gao ZG, Xu HM, Yang ZH, Jin ML. Pelvic floor reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection. Dis Colon Rectum 2010; 53:219-23. [PMID: 20087098 DOI: 10.1007/dcr.0b013e3181b715b5] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE Patients who undergo cylindrical abdominoperineal resection can have significant complications, especially those who require pelvic reconstruction using myocutaneous flaps. Reconstruction using a biomaterial may be a novel alternative. The purpose of this study is to report the initial results of pelvic reconstruction using human acellular dermal matrix after cylindrical abdominoperineal resection. METHODS Between January 2008 and February 2009, pelvic floor reconstruction was performed in 12 consecutive patients who underwent cylindrical abdominoperineal resection for advanced ultralow rectal cancer. RESULTS Two weeks after the operation, primary complete healing of the perineal wound was seen in 11 patients. At a median follow-up of 8 months, there was no perineal wound breakdown, bulge, or herniation. One patient had an asymptomatic seroma, one patient had a perineal wound infection, and 4 patients had perineal pain that resolved. CONCLUSIONS Human acellular dermal matrix provided a safe alternative for the reconstruction of large pelvic defect in the patients after cylindrical abdominoperineal resection.
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Affiliation(s)
- Jia Gang Han
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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