The use of human acellular dermal matrices in advanced wound healing and surgical procedures: State of the art

Abstract

Wound closure after post-traumatic injuries and/or localized at peculiar body sites (head-and-neck, oral cavity, legs) are particularly challenging and can often be delayed due to local and systemic factors. In case of deep wounds and/or hard-to-heal wounds, grafting of dermal acellular matrices (ADM) is often needed. Though a great variety of synthetic and semisynthetic dermal and skin equivalents are available, viable human dermis, is still considered the most physiological alternative to replace the loss of autologous dermis, by acting as a physiological scaffold that add structural support to soft tissues. To date, human ADMs (hADMs) have been employed in the reconstruction of skin defects affecting almost all body sites, ranging from visceral sites to the skin and subcutaneous tissues. This review aims to investigate the use of hADM at different body sites and their peculiar advantages. A literature search was using the search terms "acellular dermal matrices", "dermal regeneration", "advances wound healing", "human acellular dermal matrices surgery". A total of 50 out of 150 papers was included. Based on the current body if evidence, hADMs appear to bring several advantages, such as: protection of deep structures (eg, tendons, bones, cartilage and nerves); stimulation of a functional new dermis (rather than a scar); reduction of wound closure time; control of pain and exudate. Finally, hADMs may represent the best treatment option for hard-to-heal wound not only in terms of efficacy and patient satisfaction bout also in terms of sanitary costs, especially across Europe, where hADMs cannot be commercialized as medical devices.

Application of Allogeneic Human Acellular Dermal Matrix Reduces the Incidence of Fistula in Hypospadias Repair

“…HADM is an allogeneic skin material. During HADM manufacture, tissue engineering technology is used to remove all cells in the epithelium and dermis to avoid rejection during implantation, while retaining type IV collagen with its biochemical and structural effects ( 28 ). The three-dimensional structure is composed of low antigen substances such as protein, elastin, and proteoglycan, and can be used as a good scaffold for the growth of epithelial cells, fibroblasts, and new blood vessels after transplantation ( 29 ).…”

The Comparison of Breast Reconstruction Using Two Types of Acellular Dermal Matrix after Breast-Conserving Surgery

“…The ADM was studied to replace extensively burned skin for the first time [ 19 ]. Since then, using the ADM has evolved in various surgical fields, such as protection for wounds, tendons, bones, cartilage, and nerves [ 20 , 21 ], as well as the reconstruction of various organs in the human body [ 22 ]. The ADM is used for implant wrapping in nipple-sparing mastectomy and skin-sparing mastectomy nowadays, and has already secured stability.…”

A Polymer-Biologic Hybrid Hernia Construct: Review of Data and Early Experiences

“…The biologic materials are processed to remove cells and DNA of the source species to create an immunologically inert scaffold for remodeling, though the quality and extent of this is dependent upon the processing methods [27,28]. While these materials show promise, unfortunately, they are expensive and due to the retention of the protein elastin, may stretch over time [29][30][31].…”

“…In a single surgeon study, Ferzoco investigated whether use of OviTex in inguinal hernia repair was effective in repairing the defect, reducing recurrence, and preventing chronic postoperative pain (Table 1) [56]. Thirty-one (31) patients, treated on an outpatient basis, underwent inguinal hernia repair with OviTex. There were no reported surgical site infections (SSI) during the initial 30 days postoperatively.…”