Temporary Use of Acellular Dermal Matrix in Upper Extremity Salvage

Abstract

Summary: Wound coverage of exposed vascular bypasses after acute limb revascularization may not be immediately possible, while delay may create a hostile environment for the bypass graft. The use of negative-pressure wound therapy may not be possible because of extrinsic compression. Temporary use of acellular dermal matrix can help salvage upper extremity. We present 2 patients with brachial artery transection secondary to blunt trauma, who had revascularization with interposition saphenous vein grafts. We used acellular dermal matrix as temporary coverage for the exposed arterial bypass grafts to allow for patient stabilization, serial debridement, and demarcation of the surrounding tissues before definitive coverage. Additionally, the use of negative-pressure wound therapy caused diminished pulses in the bypass graft, creating the need for reliable temporary coverage. The acellular dermal matrix dressing was left in place until definitive closure was possible. Both patients underwent successful wound coverage with fasciocutaneous flaps without disruption, thrombosis, or infection of the bypass grafts. Follow-up at 6 months demonstrated good healing and excellent function. The use of the acellular dermal matrix provides temporary coverage of vital structures until definitive reconstruction can be performed.

Use of Dermal Substitute Matrices for Coverage of Exposed Limb Vascular Repairs: A Literature Review

“…Calligaro et al 20 found a graft failure rate of 25% with the use of local wound care and secondary healing in the management of infected lower extremity bypass grafts, and this rate was higher than local muscle flap coverage. Although Dosluoglu et al 21 described the direct application of negative pressure wound therapy (NPWT) dressing on exposed vascular grafts without intervening muscle coverage with success, this was not the case with Ali et al, 15 where vacuum-assisted closure dressing caused compression of the bypass and loss of distal pulses in the lower extremity. Moreover, direct application over blood vessels and anastomotic sites is cited as a contraindication of NPWT due to risk of bleeding.…”

Management of a mutilated hand: the current trends

“…With good debridement and antibiotic coverage, practice has shifted away from emergency flap coverage, except in situations where vascular repairs or vein grafts are exposed; then immediate flap cover becomes mandatory. In instances of exposures of critical neurovascular structures, some of us use acellular dermal matrix as temporary cover (Ali et al., 2020), although we feel flap cover is safer. Negative pressure wound therapy (NPWT) as a temporary cover is used less often in the management of mutilated hands than it is for mutilated lower limbs.…”