Clinical applications of acellular dermal matrices: A review

Abstract

Introduction The extracellular matrix (ECM) plays an integral role in wound healing. It provides both structure and growth factors that allow for the organised cell proliferation. Large or complex tissue defects may compromise host ECM, creating an environment that is unfavourable for the recovery of anatomical function and appearance. Acellular dermal matrices (ADMs) have been developed from a variety of sources, including human (HADM), porcine (PADM) and bovine (BADM), with multiple different processing protocols. The objective of this report is to provide an overview of current literature assessing the clinical utility of ADMs across a broad spectrum of applications. Methods PubMed, MEDLINE, EMBASE, Scopus, Cochrane and Web of Science were searched using keywords ‘acellular dermal matrix’, ‘acellular dermal matrices’ and brand names for commercially available ADMs. Our search was limited to English language articles published from 1999 to 2020 and focused on clinical data. Results A total of 2443 records underwent screening. After removing non-clinical studies and correspondence, 222 were assessed for eligibility. Of these, 170 were included in our synthesis of the literature. While the earliest ADMs were used in severe burn injuries, usage has expanded to a number of surgical subspecialties and procedures, including orthopaedic surgery (e.g. tendon and ligament reconstructions), otolaryngology, oral surgery (e.g. treating gingival recession), abdominal wall surgery (e.g. hernia repair), plastic surgery (e.g. breast reconstruction and penile augmentation), and chronic wounds (e.g. diabetic ulcers). Conclusion Our understanding of ADM’s clinical utility continues to evolve. More research is needed to determine which ADM has the best outcomes for each clinical scenario. Lay Summary Large or complex wounds present unique reconstructive and healing challenges. In normal healing, the extracellular matrix (ECM) provides both structural and growth factors that allow tissue to regenerate in an organised fashion to close the wound. In difficult or large soft-tissue defects, however, the ECM is often compromised. Acellular dermal matrix (ADM) products have been developed to mimic the benefits of host ECM, allowing for improved outcomes in a variety of clinical scenarios. This review summarises the current clinical evidence regarding commercially available ADMs in a wide variety of clinical contexts.

Application of Acellular Dermal Matrix in Gynaecology—A Current Review

“…These treatments include, among others, burn treatments, hernia repair, breast reconstruction, etc. [ 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Moreover, there are several reports on the use of ADMs in gynaecological reconstructive surgery [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ].…”

Braxon®-assisted prepectoral breast reconstruction: A decade later

“…The matrix acts as a scaffold promoting host tissue growth (93,104) and the clinical outcome is tissue reconstitution with matrix transformation into viable self-tissue (63,105). Evidence of such a result is confirmed by clinical and histological studies: the constructive remodeling process begins immediately after implantation of the Braxon® matrix and continues for the following months, during which the collagen scaffold is progressively integrated into the host tissue.…”

“…The biological processes triggered by the matrix do not lead to an absorption of the membrane, but rather to a series of phenomena collectively named “constructive remodeling”: cellular infiltration, physiological degradation, modulation of inflammation, deposition of a new extracellular matrix, and neovascularization ( 63 , 93 , 102 , 103 ). The matrix acts as a scaffold promoting host tissue growth ( 93 , 104 ) and the clinical outcome is tissue reconstitution with matrix transformation into viable self-tissue ( 63 , 105 ). Evidence of such a result is confirmed by clinical and histological studies: the constructive remodeling process begins immediately after implantation of the Braxon® matrix and continues for the following months, during which the collagen scaffold is progressively integrated into the host tissue.…”

Oropharyngeal reconstruction after transoral robotic surgery

“…Regarding the base of tongue (BOT), the authors further advocate for granulation even in T3 tumors and more extensive resections given the lack of long-term swallowing dysfunction based upon their experience in TORS for obstructive sleep apnea surgery [24]. Split-thickness skin grafts (STSGs) and acellular dermal matrices (ADMs) may also be used after resection of early staged lesions, depending on the size and location of the specific defect [25]. Bolster placement may be required to promote graft take; however, this may result in airway obstruction and be difficult or unsafe to remove in the awake patient.…”