The use of human acellular dermal matrices in irradiated breast reconstruction

This article examines the effects of radiation on prosthetic breast reconstruction when human dermal allograft is used in the reconstruction. A brief review of radiation terminology and techniques as applied to the breast is given, followed by a review of the effects of radiation on wound healing in human tissue. The effects of radiation on prosthetic breast reconstruction before the advent of dermal allografting are reviewed. The addition of dermal allograft in reconstruction has led to a reduced number of complications. An algorithm for surgical treatment of irradiated prosthetic breast reconstructions is presented, with a discussion of the authors technique.     

Use of human acellular dermal matrix for abdominal wall reconstructions

Background

Acellular dermal matrix (ADM) represents a promising new fascial substitute for repairing abdominal wall defects.

Methods

We retrospectively studied 63 patients who underwent fascial reconstruction with ADM and analyzed risk factors for recurrence and infectious wound complications.

Results

Postoperative wound infections, noninfectious wound complications, and recurrences developed in 35%, 44%, and 41% of patients, respectively. No patients required ADM removal. Long surgical times (≥300 min), implants of 100 cm² or greater, and repairs using 3 or more ADM sheets were associated significantly with the development of a postoperative wound infection. The approximation of ADM directly to the fascial edge (P = .02), long surgical time (P < .01), implant size of 100 cm² or greater (P = .01), and the presence of a postoperative wound infection (P = .02) were associated significantly with recurrence.

Conclusions

Recurrences and complications after ADM fascial repairs may be higher than previously reported and associated with implant size and method of implantation. Postoperative infection, although not necessitating implant removal, is associated with more recurrences.     

Emerging applications for acellular dermal matrices in mastopexy

This article explores whether some new acellular dermal matrices (ADMs) can be applied to breast augmentation or reconstruction revision, and particularly whether they can withstand the centripetal pull and prevent recurrent stretch deformities following periareolar mastopexy. Acellular dermis use in breast reconstruction and aesthetic breast revision is a fortuitous development, because their original purpose was for burn reconstruction. Although level 1 evidence remains lacking, ADMs have become integral adjuncts in breast reconstruction, complex hernia, and aesthetic breast revision. New applications continue to be explored, although these are in early stages of development and their long-term value remains to be confirmed.     

异种真皮去细胞基质在尿道重建中的临床应用

目的 观察异种真皮来源的去细胞基质移植物(acellular matrix graft,ACMG)作为尿道狭窄重建手术替代材料应用于临床的安全性与有效性.方法 将ACMG作为尿道重建的替代材料,观察尿路上皮细胞能否长入并形成通畅的新尿道以及有无排斥反应.采用ACMG治疗尿道狭窄病例10例,年龄20 ～ 62,平均36岁.狭窄长度3.0 ～15.0 cm,平均6.9 cm.术时采用狭窄段切除后ACMG尿道套入术或狭窄段切开后ACMG补片尿道修补术,术后6个月拔除尿管,观察该ACMG在人体中有无排斥反应及ACMG辅助尿道重建术的治疗效果. 结果 10例患者拔除尿管后均恢复排尿,尿道造影及尿道镜检查可见术后尿道连续性好,腔内黏膜连续.随访至术后18个月,出现尿道狭窄2例,经尿道内切开扩张后恢复正常排尿,其余患者均可通过尿道正常排尿. 结论 异种真皮ACMG应用于尿道成形术中具有生物相容性良好、能从解剖上和功能上修复尿道的优点,适用于复杂、长段尿道狭窄病例的成形手术.     

Creation of an acellular dermal matrix from frozen skin

At present, one of the treatments of choice for closure of full-thickness skin loss is to use a cultured epidermal autograft when skin loss is extensive. In this study, we investigated a simple method of processing frozen surplus skin to produce an acellular, structurally intact, dermal matrix. First, the acellular dermal matrix prepared from normal human skin (ADM) we processed was observed using a transmission electron microscope and a scanning electron microscope. The matrix maintained the basement membrane complex and the extracellular matrix structure of the dermis despite frozen skin being used. Next, using an animal model, we transplanted the ADM and Pelnac, which is used as a contrast in full-thickness wounds onto nude rats. The dermal matrix supported fibroblast infiltration and neovascularization. These results suggest that skin processed by our simple method has the potential to be used as a dermal template together with the cultured epidermis in the closure of full-thickness wounds.     

Use of human acellular dermal matrix in complex and contaminated abdominal wall reconstructions

BACKGROUND: Few good surgical options exist for the repair of complex anterior abdominal wall defects, particularly those in which bacterial contamination is present. The use of prosthetic mesh increases complication rates when the mesh is placed directly over viscera or when the surgical site is contaminated from a pre-existing infection or enteric spillage. The use of an acellular dermal matrix (ADM), which becomes vascularized and remodeled into autologous tissue after implantation, may represent a low-morbidity alternative to prosthetic mesh products in these complex settings. This study examined our experience with ADM in the reconstruction of contaminated abdominal wall defects. METHODS: Patients undergoing abdominal wall reconstructions in the face of contamination with ADM between May 2002 and December 2005 underwent retrospective chart review. Demographics, indications for ADM placement, plane of implantation, complications, and follow-up data were evaluated. RESULTS: Sixty-seven patients were identified. The indications for ADM placement included incarcerated hernias, infected mesh, fistulae, early/delayed abdominal wall reconstruction after intra-abdominal catastrophe or trauma, dehiscence/evisceration, and spillage of enteric contents. The ADM was positioned either above the fascia or beneath the fascia or was sutured directly to the fascial edges. Sixteen patients developed a wound infection; the majority of these were superficial and required only local wound care, 5 required some further surgical intervention, and 2 required removal of the ADM. Twelve patients developed recurrent hernias. The mean follow-up time for the study population was 10.6 months. CONCLUSIONS: ADM can be used safely and effectively as an alternative to traditional mesh products for abdominal wall reconstructions, even in the setting of contaminated fields.     

Use of porcine acellular dermal matrix as a dermal substitute in rats

OBJECTIVE: To examine porcine acellular dermal matrix (ADM) as a xenogenic dermal substitute in a rat model. SUMMARY BACKGROUND DATA: Acellular dermal matrix has been used in the treatment of full-thickness skin injuries as an allogenic dermal substitute providing a stable wound base in human and animal studies. METHODS: Xenogenic and allogenic ADMs were produced by treating porcine or rat skin with Dispase and Triton X-100. Full-thickness skin defects (225 mm2) were created on the dorsum of rats (n = 29), porcine or rat ADMs were implanted in them, and these were overlain with ultrathin split-thickness skin grafts (STSGs). In two adjacent wounds, 0.005- or 0.017-inch-thick autografts were implanted. In other experiments, the antimicrobial agent used during ADM processing (azide or a mixture of antibiotics) and the orientation of the implanted ADM (papillary or reticular side of ADM facing the STSG) were studied. Grafts were evaluated grossly and histologically for 30 days after surgery. RESULTS: Significant wound contraction was seen at 14, 20, and 30 days after surgery in wounds receiving xenogenic ADM, allogenic ADM, and thin STSGs. Contraction of wounds containing xenogenic ADM was significantly greater than that of wounds containing allogenic ADM at 30 days after surgery. Graft take was poor in wounds containing xenogenic ADM and moderately good in those containing allogenic ADM. Wound healing was not significantly affected by the antimicrobial agent used during ADM preparation or by the ADM orientation. CONCLUSION: Dispase-Triton-treated allogenic ADM was useful as a dermal substitute in full-thickness skin defects, but healing with xenogenic ADM was poor.     

脱细胞真皮在整形外科领域的应用进展

脱细胞真皮基质,分为异体脱细胞真皮基质和异种脱细胞真皮基质,分别由异体皮肤和异种动物皮肤处理后获得。它产生于烧伤治疗的实践当中,治疗急性期深度烧伤时的供区不足是整形外科领域中最棘手的问题之一。大面积深度烧伤患者后期常遗留严重的瘢痕增生及挛缩畸形,切除瘢痕、松解瘢痕挛缩、     

The use of acellular dermal regeneration template for recalcitrant pilonidal disease

Numerous techniques have been described for the treatment of pilonidal disease, yet there remains no consensus on the optimal management of recurrent pilonidal disease. Pilonidal wounds often lack the structural integrity to heal over and Integra provides a scaffold for the regrowth of an autogenous dermis from the patient's own fibroblasts and collagen. Postoperative negative pressure wound therapy (NPWT) may speed vascularisation of Integra, re-epithelialisation, and wound closure. This case report concerns two patients with chronic pilonidal sinuses who underwent wide excision and placement of Integra with postoperative NPWT. Postoperatively, the patients were assessed for complications and recurrence. Both patients went on to heal and did not require further surgical treatment after a median follow-up of 29?months. Integra may help prevent pocket or cyst formation during the closure process and provides a neodermis, allowing for full re-epithelialisation. More research and a longer follow-up are needed to evaluate the role of Integra and NPWT in recurrent pilonidal disease.     

In-vivo and in-vitro histological evaluation of two commercially available acellular dermal matrices

Purpose  

Post-herniation abdominal wall repair can be performed with synthetic or biologic meshes. Synthetics have been associated with complications, so biologics are promising alternatives. The methods used to decellularize biological matrices may affect the extracellular components. This study evaluated the post-implantation biological response of two allogenic acellular dermal matrices (ADMs) in a hernia model.     

骨髓间充质干细胞复合组织工程化脱细胞真皮基质构建组织工程皮肤

目的：体外培养扩增SD大鼠骨髓间充质干细胞（bone marrow mesenchymal stem cells,BMSCs），复合组织工程化脱细胞真皮基质构建组织工程皮肤，为进一步临床应用奠定基础。方法：将SD大鼠骨髓间充质干细胞进行体外培养扩增后，以生长状态良好的骨髓间充质干细胞接种于制备好的组织工程化脱细胞真皮支架上，进行体外联合培养，构建组织工程皮肤。观察细胞生长情况及组织工程皮肤结构。结果：体外培养的SD大鼠骨髓间充质干细胞生长良好，传代扩增容易，组织工程化脱细胞真皮基质去细胞完全，骨髓间充质干细胞在脱细胞真皮基质中生长良好，可体外构建组织工程皮肤。结论：利用体外扩增培养的骨髓间充质干细胞及制备的组织工程化脱细胞真皮基质可以体外联合构建组织工程皮肤。     

A randomized clinical trial of a human acellular dermal matrix demonstrated superior healing rates for chronic diabetic foot ulcers over conventional care and an active acellular dermal matrix comparator

This study compared the efficacy and safety of a human acellular dermal matrix (ADM), D‐ADM, with a conventional care arm and an active comparator human ADM arm, GJ‐ADM, for the treatment of chronic diabetic foot ulcers. The study design was a prospective, randomized controlled trial that enrolled 168 diabetic foot ulcer subjects in 13 centers across 9 states. Subjects in the ADM arms received one application but could receive one additional application of ADM if deemed necessary. Screen failures and early withdrawals left 53 subjects in the D‐ADM arm, 56 in the conventional care arm, and 23 in the GJ‐ADM arm (2:2:1 ratio). Subjects were followed through 24 weeks with major endpoints at Weeks 12, 16, and 24. Single application D‐ADM subjects showed significantly greater wound closure rates than conventional care at all three endpoints while all applications D‐ADM displayed a significantly higher healing rate than conventional care at Week 16 and Week 24. GJ‐ADM did not show a significantly greater healing rate over conventional care at any of these time points. A blinded, third party adjudicator analyzed healing at Week 12 and expressed “strong” agreement (κ = 0.837). Closed ulcers in the single application D‐ADM arm remained healed at a significantly greater rate than the conventional care arm at 4 weeks posttermination (100% vs. 86.7%; p = 0.0435). There was no significant difference between GJ‐ADM and conventional care for healed wounds remaining closed. Single application D‐ADM demonstrated significantly greater average percent wound area reduction than conventional care for Weeks 2–24 while single application GJ‐ADM showed significantly greater wound area reduction over conventional care for Weeks 4–6, 9, and 11–12. D‐ADM demonstrated significantly greater wound healing, larger wound area reduction, and a better capability of keeping healed wounds closed than conventional care in the treatment of chronic DFUs.     

Use of homologous acellular dermal matrix for abdominal wall reconstruction in rats.

Homologous acellular dermal matrix graft (HADMG) has been used for the reconstructions of bowel, bladder, or urethra, but its suitability in the reconstruction of abdominal wall has not been tested. Therefore an experimental study was performed to evaluate the use of HADMG for the reconstruction of abdominal wall defects in weanling rats. Thirty weanling Wistar rats were used. A patch of abdominal wall 20 x 20 mm in dimension was removed. The defects were reconstructed with HADMGs that were derived from rat skin and prepared through a detergent enzymatic method. The reconstructed abdominal walls were evaluated as hernia rate and graft take ratio, excised and prepared for histological examination at 21 (n = 10), 40 (n = 10), and 90 (n = 10) days postoperation. The healing of repaired abdominal walls was uneventful. Histological evaluation demonstrated the migration of fibroblasts and neovascularization within the HADMG. Hernia in four rats were developed at 90 days. Neither significant wound contraction nor inflammation was seen at 21, 40, and 90 days after surgery in wounds receiving HADMGs. Thus, the use of a HADMG for reconstructing the abdominal wall in weanling rats has not given rise to any complications. HADMG has progressively remodeled into fibrous tissue. It appears to represent an important alternative substitute for the reconstruction of abdominal wall.     

异种脱细胞真皮基质的制作和临床应用观察

目的　降低异种 (猪 )真皮组织的抗原性 ,探讨在临床复合移植的可行性。　方法　健康小猪中厚皮 ,半数经戊二醛交联后采用胰蛋白酶和TritonX 10 0等脱细胞处理 ,制成未交联(sADM0 )和交联型 (sADM1)网状脱细胞真皮基质 ,通过动物实验和临床应用 ,观察 2种sADM组织学变化和移植效果。　结果　 (1)兔皮下埋植sADM0 宿主细胞侵入迅速 ,炎症反应和组织降解明显 ,而sADM1炎症反应轻 ,皮片降解和收缩不明显 ;(2 ) 10例烧伤患者Ⅲ度创面和 1例胸部瘢痕切除后 ,以自体薄中厚皮 (ATS)和自体刃厚皮或超薄皮 (UTS)为对照 ,进行sADM UTS复合移植 ,19块复合皮平均成活率为 78.9% ,与ATS组无显著差异。其中sADM0 UTS组早期炎症反应和创面收缩明显 ,外观效果与UTS组相当 ;在sADM1 UTS组 ,早期炎症反应和创面收缩较轻 ,外观平整 ,触软 ,与ATS组移植效果相当 ,但有 3例患者的 6块创面在术后平均 (12 .8± 6 .9)周时 ,出现表皮破溃、sADM1外露和组织学严重的异物巨噬细胞反应。　结论　临床用交联型sADM作复合皮的真皮替代物 ,能减缓早期免疫反应 ,提高UTS移植效果 ,但仍不可避免迟发性异种排异反应。     

异体脱细胞真皮基质与自体皮片复合移植的临床应用

目的:探讨异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面及其愈合后皮肤的外形和功能。方法:应用异体脱细胞真皮基质与自体刃厚皮片组成复合皮移植,以自体刃厚皮片移植作为对照,采用一步移植法治疗切痂后大面积深度烧伤创面及瘢痕切除后皮肤缺损共56例患者60处创面,观察术后皮片的成活情况、外形及功能恢复情况并随访。结果:60处创面全部愈合,移植皮片生长良好,瘢痕增生不明显,未见明显挛缩,皮肤弹性较好。在6～12个月的观察期内,自体刃厚皮片与异体脱细胞真皮基质复合移植后,功能和形态优于单纯自体刃厚皮片移植;随访2年复合移植未发现明显的排异反应。结论:异体脱细胞真皮基质与自体皮片复合移植修复大面积深度烧伤及瘢痕切除后皮肤缺损创面愈合良好,无瘢痕增生,皮肤外观功能满意,无排异反应。