Dilek ÖF, Sevim KZ, Dilek ON. Acellular dermal matrices in reconstructive surgery; history, current implications and future perspectives for surgeons. World J Clin Cases 2024; 12(35): 6791-6807 [DOI: 10.12998/wjcc.v12.i35.6791]
Corresponding Author of This Article
Ömer F Dilek, MD, Assistant Professor, Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, 34396, Sarıyer, İstanbul 34396, Türkiye. ofdilek@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Human acellular dermal matrix allograft: A randomized, controlled human trial for the long-term evaluation of patients with extensive burns
This randomized controlled clinical trial of human acellular dermal matrix (ADM) showed that the composite graft of human ADM with thinner split-thickness skin graft could provide acceptable esthetic outcomes, good functional recovery, and less scar formation at the donor site
Multicenter postapproval clinical trial of Integra dermal regeneration template for burn treatment
Integra® has been found useful in postburn reconstructive procedures both for pediatric and adult patients, affording improved cosmetic results. It clearly provides a valuable, effective and safe clinical treatment modality for dealing with the difficult clinical management challenge posed by the extensively burned patient
An objective long-term evaluation of Integra (a dermal skin substitute) and split thickness skin grafts, in acute burns and reconstructive surgery
Authors conclude that when objectively measured ADM treated sites correlate well with subject’s normal skin elasticity whilst no correlation was seen with the subject’s skin grafted sites
Use of porcine acellular dermal matrix following early dermabrasion reduces length of stay in extensive deep dermal burns
In this retrospective study authors conclude that early dermabrasion combined with porcine ADM coverage facilitates wound healing, decreases the length of hospital stay, and improves esthetic and functional results in extensive deep dermal burns of adult patients
Multicenter effect analysis of one-step acellular dermis combined with autologous ultra-thin split thickness skin composite transplantation in treating burn and traumatic wounds
In this open, randomized, controlled, multicenter study, the authors suggest that ADMs can be successfully combined with partial-thickness skin grafts in many other acute traumatic and chronic non-burn wounds
Table 3 Clinical evidence examples of the utilization of acellular dermal matrix in various chronic wounds
Human-derived Acellular Dermal Matrix Grafts for Treatment of Diabetic Foot Ulcers: A Systematic Review and Meta-analysis
Authors conclude that Human-derived acellular dermal matrices (ADMs) are associated with a higher likelihood of complete healing and fewer days to complete healing within a 12-week and 16-week periods when compared with standard of care
The use of fetal bovine acellular dermal matrix in severe diabetic foot ulceration and threatened limbs with tissue loss the use of FBADM as an adjunct for complex wounds
Authors conclude that ADM may be a useful adjunct in the acute setting of complex diabetic foot disease and critical limb-threating ischemia ulceration to assist with wound healing
The Role of Dermal Matrices in Treating Inflammatory and Diabetic Wounds
Authors review wide range of inflammatory wounds such as pyoderma gangrenosum, sickle cell ulcer, sarcoid ulcer as well as diabetic foot ulcer where ADMs may enhance the regenerative potential
An aseptically processed, acellular, reticular, allogenic human dermis improves healing in diabetic foot ulcers: A prospective, randomised, controlled, multicentre follow-up trial
This randomized controlled trial demonstrates the effectiveness of the human derived ADM in facilitating the closure of nonhealing diabetic foot ulcers refractory to standard of care
A Randomized Controlled Trial Comparing a Human Acellular Dermal Matrix Versus Conventional Care for the Treatment of Venous Leg Ulcers
According to this multicenter, randomized, controlled, open-label trial, authors conclude that successful increase in healing rates and rate of percent wound closure in ADM application as compared with conventional care options
Fetal Bovine Dermal Repair Scaffold Used for the Treatment of Difficult-to- Heal Complex Wounds
Authors conclude that ADMs can be used as part of an effective treatment regimen to heal complex wounds with exposed tendon/bone caused by varying etiologies
Table 4 Clinical evidence examples of the utilization of acellular dermal matrix in breast surgery
Prepectoral implant-based breast reconstruction: Rationale, indications, and preliminary results
In this report, the authors discuss the rationale for prepectoral implant reconstruction, its indications/contraindications, and preliminary results from over 350 reconstructions
The Journey of Prepectoral Breast Reconstruction through Time
Authors review the breast reconstruction history and favor prepectoral implant placement. They also encourage the use of acellular dermal matrix (ADM)/Synthetic Mesh with prepectoral breast reconstruction as they are an efficient and effective mode of breast reconstruction, causing minimal morbidity whilst providing good cosmesis
Prepectoral versus Subpectoral Tissue Expander Breast Reconstruction: A Historically Controlled, Propensity Score-Matched Comparison of Perioperative Outcomes
When compared two groups, authors found similar rates of overall perioperative complications. However, prepectoral placement might reduce unnecessary clinic visits; shorten the delay before adjuvant therapy, and minimize patient apprehension, pain, and discomfort related to clinic-based expansion
Authors suggest that the prepectoral two-stage approach is indicated in the majority of patients and can be performed with fewer complications using ADM, especially in patients who will receive radiotherapy
A Safe Alternative to Submuscular Prosthetic Reconstruction following Nipple-Sparing Mastectomy
After two-staged implant reconstructions with ADM, analysis revealed no difference in total complication rate between the two groups and no differences in any of the individual complications measured that included infection, seroma and explantation
The use of acellular dermal matrices in chest wall reconstruction
First review of acellular dermal matrix (ADM) utilization in chest wall defects. Authors share their experiences and conclude that they favor acellular dermal matrices when there is concern for possible field contamination, active infection, or concern over wound healing
Chest Wall Reconstruction with Porcine Acellular Dermal Matrix (Strattice) and Autologous Tissue Transfer for High Risk Patients with Chest Wall Tumors
Reconstruction 7 sarcoma and 1 breast cancer resection involving chest wall. Authors encourage ADM use in chest wall reconstruction to resist infection in high-risk patients with extensive defects
Chest wall osteochondroma resection with biologic acellular bovine dermal mesh reconstruction in pediatric hereditary multiple exostoses: A case report and review of literature
Resection and ADM involving reconstruction of a 5-year-old
Outcomes after abdominal wall reconstruction using acellular dermal matrix: a systematic review
Authors conclude the need for high-level evidence when comparing acellular dermal matrix (ADM) use with other methods to make data-driven recommendations on clinical indications, surgical techniques and outcomes following ADM-assisted abdominal wall reconstruction
Outcomes Analysis of Biologic Mesh Use for Abdominal Wall Reconstruction in Clean-Contaminated and Contaminated Ventral Hernia Repair
Authors conclude that single-stage repair of grade 3 hernias performed with component separation and biologic mesh reinforcement is effective and offers a low recurrence rate. The use of biologic mesh allows for avoidance of mesh explantation in instances of wound breakdown or infection. Bridging repairs are associated with a high recurrence rate, as is single-stage repair of grade 4 hernias
Major Complex Abdominal Wall Repair in Contaminated Fields with Use of a Non-cross-linked Biologic Mesh: A Dual-Institutional Experience
Author proposes that the repair of the most challenging abdominal wall defect can be done effectively with combination of a non-cross-linked biologic mesh and component separation technique without the need for mesh removal despite wound infections
Component Separation Decreases Hernia Recurrence Rates in Abdominal Wall Reconstruction with Biologic Mesh
Authors concluded that the component separation technique combined with ADM was associated with fewer hernia recurrences, while surgical site occurrence was similar in long-term follow-up despite additional surgery
Table 7 Clinical evidence examples of the utilization of acellular dermal matrix in head and neck
A Prospective Study Investigating Fistula Rate Following Primary Palatoplasty Using Acellular Dermal Matrix
This prospective study proposes the routine use of ADM in Veau II-IV clefts since it significantly reduce the fistula rate when compared their retrospective cohort
Comparison of the use of allogenic acellular dermal matrix on rates of Frey syndrome post parotidectomy: A systematic review and meta-analysis
Authors conclude that the use of ADM was associated with lower Frey syndrome rates compared to no ADM and should be considered in routine use to prevent this condition
Human-derived acellular dermal matrix may be an alternative to autologous grafts in tympanic membrane reconstruction: systematic review and meta-analysis
Authors conclude that human-derived ADM might be an effective alternative to autologous grafts for tympanoplasty
Acellular dermis compared to skin grafts in oral cavity reconstruction
Authors conclude that acellular dermis grafting for reconstruction of the oral cavity offers several advantages over split-thickness skin graft, including the lack of donor site morbidity, lower cost, a natural appearing mucosal surface, and comparable if not superior functional status
Dural repair using acellular human dermis: experience with 200 cases: technique assessment
Authors conclude that acellular human dermis is a reasonable alternative to the available dural graft materials. Its handling characteristics are similar to those of dura, it is biologically inert, and it does not produce adhesion formation
Comparison of xenogeneic acellular dermal matrix and skin grafts in reconstruction of postoperative defects of hypopharyngeal cancer: A retrospective cohort study
Authors conclude that both ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with ADM was faster, which may be due to rapid epithelialization
Acellular Human Dermal Allograft as a Graft for Nasal Septal Perforation Reconstruction
Authors conclude that as the first study to use objective and subjective measurements to confirm success with acellular dermis allograft as an adjunct for septal perforation repair it demonstrated a statistically significant reduction in patient nasal symptoms following repair
Correction of Lower Eyelid Retraction with En Glove Placement of Porcine Dermal Collagen Matrix Implant
Authors describe the technique for mild to moderate retractions. The operative time is brief (< 30 minutes), with limited dissection and resultant minimal to no clinically significant ocular surface inflammation postoperatively
Prevention and Resolution of Silicone Implant-Related Problems in Secondary Rhinoplasty Using a Cross-Linked Human Acellular Dermal Matrix
Authors conclude that dorsal augmentation using the cross-linked human ADM along with various nasal tip work using autogenous cartilage. Surgical outcome showed favorable resolution of contracture deformities, a low infection rate, firm fixation of the implant, good skin texture/thickness of the skin/soft tissue envelope and gain of desired height and dorsal line
Current Practices in Dorsal Augmentation Rhinoplasty
Authors describe acellular dermal matrices are alternatives to autologous graft with many similar advantages and no need for an additional surgical site
Table 8 Clinical evidence examples of the utilization of acellular dermal matrix in extremity
Orthopedic applications of acellular human dermal allograft for shoulder and elbow surgery
Authors review a wide variety of orthopedical applications of acellular dermal matrices (ADMs) such as, rotator cuff tears, latissimus dorsi transfers, pectoralis major and biceps tendon repairs, glenoid resurfacing and acromioclavicular reconstruction
Use of Acellular Dermal Matrix Following Fasciectomy for the Treatment of Dupuytren's Disease
Authors conclude that the adjunct placement of acellular dermal matrix into the wound bed following fasciectomy may be an important surgical strategy to reduce recurrence rates as well as augment coverage of exposed vital structures in cases of severe flexion contracture
A comprehensive review for ADM-assisted reconstruction of difficult skin and soft tissue defects resulted from various etiologies such as, ischemia, infection, advanced Dupuytren disease and burn contractures
Preventing postoperative adhesions after hand tendon repair using acellular dermal matrix
Authors conclude that he use of ADM after tendon repair has the potential to significantly improve the outcome of tendon surgery in terms of range of motion
Citation: Dilek ÖF, Sevim KZ, Dilek ON. Acellular dermal matrices in reconstructive surgery; history, current implications and future perspectives for surgeons. World J Clin Cases 2024; 12(35): 6791-6807