Acellular dermal matrix contributes to epithelialization in patients with chronic sinusitis

Acellular dermal matrix in reconstructive surgery: Applications, benefits, and cost

Modern tissue engineering has made substantial advancements that have revolutionized plastic surgery. Acellular dermal matrix (ADM) is an example that has gained considerable attention recently. ADM can be made from humans, bovines, or porcine tissues. ADM acts as a scaffold that incorporates into the recipient tissue. It is gradually infiltrated by fibroblasts and vascularized. Fortunately, many techniques have been used to remove cellular and antigenic components from ADM to minimize immune system rejection. ADM is made of collagen, fibronectin, elastin, laminin, glycosaminoglycans, and hyaluronic acid. It is used in critical wounds (e.g., diabetic wounds) to protect soft tissue and accelerate wound healing. It is also used in implant-based breast reconstruction surgery to improve aesthetic outcomes and reduce capsule contracture risk. ADM has also gained attention in abdominal and chest wall defects. Some studies have shown that ADM is associated with less erosion and infection in abdominal hernias than synthetic meshes. However, its higher cost prevents it from being commonly used in hernia repair. Also, using ADM in tendon repair (e.g., Achilles tendon) has been associated with increased stability and reduced rejection rate. Despite its advantages, ADM might result in complications such as hematoma, seroma, necrosis, and infection. Moreover, ADM is expensive, making it an unsuitable option for many patients. Finally, the literature on ADM is insufficient, and more research on the results of ADM usage in surgeries is needed. This article aims to review the literature regarding the application, Benefits, and costs of ADM in reconstructive surgery.

Acellular Dermal Matrix in Plastic and Reconstructive Surgery

Despite significant advances in medical research, plastic surgeons still face a shortage of suitable patient tissues, and soft tissue reconstruction is no exception. In recent years, there has been a rapid boom in the use of acellular dermal matrix (ADM) in reconstructive and aesthetic surgery. ADM is incorporated into the surrounding tissue and gradually replaced by the host's collagen, thus promoting and supporting the healing process and reducing the formation of scar tissue. The main goal of this article is to provide a brief review of the current literature assessing the clinical applications of ADM across a broad spectrum of applications in plastic and reconstructive surgery.

Treatment and Impacts of Chronic Sinusitis with the Confluence of Biyuan Tongqiao Granules and Saline Nasal Irrigation

In this research study, we will study the clinical effect of Biyuan Tongqiao granules with saline nasal irrigation for treatment of chronic sinusitis. It will also study its impacts on the computed tomography (CT) score of the nasal sinus and negative reactions in patients. For this purpose, ninety (90) patients with chronic sinusitis were admitted to the hospital (June 2019 to June 2020). They were selected as the research subjects and divided into experimental and control groups randomly with 45 cases in each group. Control group patients were treated with nasal irrigation with normal saline. While, Biyuan Tongqiao granules combined with nasal irrigation with normal saline was treated by the experimental group. The CT scores of nasal sinus, clinical effect, the incidence of adverse reactions, recurrence rate, duration of nasal mucosal epithelialization, and nasal ciliary transmission speed of both the groups were compared. The patients' pain was assessed by the visual analogue scale (VAS), and the symptoms of sinusitis were scored by the SNOT-20 scale. The experimental group showed significantly lower sinus CT scores and better clinical effects. Adverse reactions were not observed in both the groups' probability (P > 0.05). The experimental group presented a significantly lower recurrence rate, shorter duration of nasal mucosal epithelialization, faster nasal ciliary transmission, and sharply lowers VAS scores and SNOT-20 scores than in the control group (P < 0.05). This proves Biyuan Tongqiao granules and nasal irrigation with normal saline can effectually boost the clinical efficacy and lessen the computed tomography score of nasal sinus in chronic sinusitis patients. It has a worthy clinical application and promotion.

Tissue Engineering in Skin Substitute

Thermal injuries may cause significant damage to large areas of the skin. Extensive and deep burn wounds require specialized therapy. The optimal method in the strategy of treating extensive, full thickness burns (III°) is the use of autologous split thickness skin grafts STSG (Busuioc et al. Rom J Morphol Embryol 4:1061-1067, 2012; Kitala D, Kawecki M, Klama-Baryła A, Łabuś W, Kraut M, Glik J, Ryszkiel I, Kawecki MP, Nowak M. Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching. Adv Clin Exp Med. 2016 Sep-Oct;25(5):923-929.; Glik J, Kawecki M, Kitala D, Klama-Baryła A, Łabuś W, Grabowski M, Durdzińska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalized patients group in the Dr Stanislaw Sakiel Center for Burn Treatment between 2009 and 2015. Int Wound J. 2017 Feb 21. https://doi.org/10.1111/iwj.12720 . [Epub ahead of print]; Prim et al. May 24Wound Repair Regen., 2017; Grossova et al. Mar 31Ann Burns Fire Disasters 30:5-8, 2017). The main limitation of that method is the inadequate amount of healthy, undamaged skin (donor sites), which could be harvested and used as a graft. Moreover, donor sites are an additional wounds that require analgesic therapy, leave scars during the healing process and they are highly susceptible to infection (1-6). It must be emphasized that in terms of the treatment of severe, deep and extensive burns, and there should be no doubt that the search for a biocompatible skin substitute that would be able to replace autologous STSG is an absolute priority. The above-mentioned necessitates the search for new treatment methods of severe burn wounds. Such methods could consider the preparation and application of bioengineered, natural skin substitutes. At present, as the clinical standard considered by the physicians may be use of available biological skin substitutes, e.g., human allogeneic skin, in vitro cultured skin cells, acellular dermal matrix ADM and revitalized ADMs, etc. (Busuioc et al. Rom J Morphol Embryol 4:1061-1067, 2012; Kitala D, Kawecki M, Klama-Baryła A, Łabuś W, Kraut M, Glik J, Ryszkiel I, Kawecki MP, Nowak M. Allogeneic vs. Autologous Skin Grafts in the Therapy of Patients with Burn Injuries: A Restrospective, Open-label Clinical Study with Pair Matching. Adv Clin Exp Med. 2016 Sep-Oct;25(5):923-929.; Glik J, Kawecki M, Kitala D, Klama-Baryła A, Łabuś W, Grabowski M, Durdzińska A, Nowak M, Misiuga M, Kasperczyk A. A new option for definitive burn wound closure - pair matching type of retrospective case-control study of hand burns in the hospitalised patients group in the Dr Stanislaw Sakiel Center for Burn Treatment between 2009 and 2015. Int Wound J. 2017 Feb 21. https://doi.org/10.1111/iwj.12720 . [Epub ahead of print]; Prim et al. May 24Wound Repair Regen., 2017; Grossova et al. Mar 31Ann Burns Fire Disasters 30:5-8, 2017; Łabuś et al. FebJ Biomed Mater Res B Appl Biomater 106:726-733, 2018).