Human acellular dermal wound matrix: evidence and experience

Abstract

A chronic wound fails to complete an orderly and timely reparative process and places patients at increased risk for wound complications that negatively impact quality of life and require greater health care expenditure. The role of extracellular matrix (ECM) is critical in normal and chronic wound repair. Not only is ECM the largest component of the dermal skin layer, but also ECM proteins provide structure and cell signalling that are necessary for successful tissue repair. Chronic wounds are characterised by their inflammatory and proteolytic environment, which degrades the ECM. Human acellular dermal matrices, which provide an ECM scaffold, therefore, are being used to treat chronic wounds. The ideal human acellular dermal wound matrix (HADWM) would support regenerative healing, providing a structure that could be repopulated by the body's cells. Experienced wound care investigators and clinicians discussed the function of ECM, the evidence related to a specific HADWM (Graftjacket(®) regenerative tissue matrix, Wright Medical Technology, Inc., licensed by KCI USA, Inc., San Antonio, TX), and their clinical experience with this scaffold. This article distills these discussions into an evidence-based and practical overview for treating chronic lower extremity wounds with this HADWM.

Cell-derived matrices for tissue engineering and regenerative medicine applications

“…The main matrix components in skin are collagens, elastin, GAGs, laminin, nidogen and fibronectin 78 , and matrices derived from fibroblasts, the primary cell type within the dermis, recapitulate some the main components in adult skin 10, 57, 79 . Acellular dermal matrix allografts and skin substitutes, such as INTEGRA® Dermal Regeneration Template, are routinely used in the clinic to treat burns and chronic wounds 80-83 . However, adult skin is also known to have reduced regenerative capability compared to fetal skin.…”

A Novel Reticular Dermal Graft Leverages Architectural and Biological Properties to Support Wound Repair

“…2,6,18,21,29 Traditionally, these matrices are obtained from the papillary dermal layer and are processed by methods that can alter the native dermal architecture and tissue quality, thereby impacting host engraftment and tissue remodeling. The novel dermal graft (HR-ADM) obtained from the deep reticular dermis layer used in this study was aseptically processed, and this preserved the native architecture and key ECM components that facilitate graft integration.…”

“…5,19 ADMs can be processed to preserve the dermal structure and leverage the dermal biology to reduce scarring and improve tissue regeneration. 2,20–22 …”

“…2,24 If not designed appropriately, however, the processing can negatively impact the endogenous matrix proteins and natural architecture that can hamper host cell integration and result in encapsulation and foreign body response. 25,26 Aseptic tissue processing utilizes gentle decontamination steps to ensure tissue safety, while preserving the matrix configuration.…”

Progress in developing decellularized bioscaffolds for enhancing skin construction

“…52 To date, AlloDerm plus split-thickness autologous skin grafts have been widely adopted to cover full-thickness or deep partial-thickness burn wounds, 49 thereby reducing subsequent scarring. 62 Various other products are commercially available, including decellularized dermis products produced from porcine dermis, such as Medeor Matrix, Permacol, Strattice, and Gelfoam. 57 Biological skin substitutes can be obtained by recellularization of the acellular dermis using allogeneic keratinocytes, 58 adipose-derived stem cells, 59 fibroblasts, 60 and human umbilical vein endothelial cells.…”