Acellular Dermal Matrices: Applications in Plastic Surgery

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.

Use of a Bioabsorbable Implant-Acellular Dermal Matrix Construct to Facilitate Oncoplastic Breast-conserving Surgery

“…ADM contains collagen, elastins, laminins, proteoglycans, and a basement membrane facilitating neovascularization, cytologic ingrowth, cell propagation, migration, differentiation, fibroblast infiltration, and epithelization and efficiently incorporates into surrounding tissues. 7 The efficient integration of the ADM with well-vascularized overlying skin in the weeks after surgery and before radiotherapy may safeguard against extrusion. The ADM provides a level surface for the skin to rest upon as opposed to the irregular twirls of the BioZorb, preventing fibrotic depression of the skin in the absence of soft tissue coverage.…”

Complex abdominal wall reconstruction after oncologic resection in a sequalae of giant omphalocele: A case report

“…The combination of porcine ADM and NPWT in this case leaded to a wound bed with a healthy granulation tissue over the mesh, allowing a split-thickness graft, with a low morbidity [ 11 ]. The acellular bilayer matrices as Integra®, featured a synthetic epidermal layer are primary designed as complete skin substitute instead of ADMs [ 19 ]. Providing specific host cells to ADM as scaffold will lead to a tissue regeneration, as observed in this case with the ADM-skin graft combination allowing skin cells colonization with a dermal bed [ 20 ].…”

“…Sparing the flap option, reduced the risk to lose it in case of recidivism and preserved it for a definitive reconstruction after oncologic adjuvant treatment. Skin graft allowed the observation of local oncologic recurrence as the margin were uncertain [ 11 ], and the possibility of reoperation through the ADM mesh [ 19 ].…”

“…The acellular dermal matrix can be placed directly over a viscera and used as both temporary and permanent wound dressing in AWR [ 19 ]. This case was challenging for both digestive and reconstructive surgeons.…”

Prosthetic meshes for hernia repair: State of art, classification, biomaterials, antimicrobial approaches, and fabrication methods

“…165,166 Therefore, although this type of repair can produce satisfactory results in some cases, it is far from being a definitive method of hernia repair. 167,168 To tailor the degradation speed of the mesh and increase its stability to enzymatic decomposition, chemical crosslinking reactions can be carried out, using…”