Abdominal wall repair using human acellular dermal matrix: a follow-up study
Division of Plastic Surgery, Houston, TX, USA. American journal of surgery
(Impact Factor: 2.29).
11/2009; 198(5):650-7. DOI: 10.1016/j.amjsurg.2009.07.027
The role of acellular dermal matrix (ADM) in abdominal wall reconstruction (AWR) is unclear. The aim of this study was to review the management, complications, and long-term outcomes of AWR using ADM in a large surgical cohort.
Retrospective chart review of patients undergoing AWR using ADM from 2004 to 2007 was performed. Demographic data, comorbidities, complications, and long-term outcomes were collected.
There were 77 cases in 68 patients with mean age of 61.1 +/- 1.4 years. The most common indication was infected fascia (n = 19 [25%]). Wound closure was achieved in 75% of the cases via primary (n = 26 [45%]), secondary intention (n = 17 [29%]), or skin graft (n = 15 [26%]). Nonprimary closure was achieved in 5.7 +/- .7 months. There were 32 perioperative (39%) and 33 long-term (43%) complications. Over a mean follow-up period of 13.2 +/- 1.5 months, the hernia recurrence rate was 27% (n = 21).
Although ADM is a viable option in AWR, the high hernia recurrence rate warrants a continued search for alternative biologic materials to improve outcomes.
Available from: Chen Huang
- "An acellular dermal matrix (ADM) is a commercially available tissue graft derived from donated human skin  . ADM has been widely used since 1992 for various reconstructive surgeries, such as in cases of severe burns, recurrent hernias, abdominal wounds, and oculoplastic applications        . Clinical experience has suggested that its use in regenerative medicine can potentially offer a lower infection rate and fewer adhesions, while maintaining sufficient tensile strength. "
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ABSTRACT: The aim of this study was to analyze the viability of using an acellular dermal matrix (ADM) as a reinforcement material for peripheral corneal thinning disease. The complete removal of cell components was confirmed by hematoxylin and eosin (H&E) and 4',6-diamidino-2-phenylindole (DAPI) staining. Transmission electron microscopy determined that the stromal structure was well preserved. Uniaxial tests revealed that the ADM had strong mechanical properties. After being implanted into rabbit cornea the ADM showed no sign of rejection and even achieved good transparency 24weeks post-surgery. H&E staining demonstrated that keratocytes grew in the ADM and the ADM-cornea interface became blurry. Picrosirius red staining revealed great changes of collagen in the ADM. Uniaxial testing of the reinforced cornea showed better mechanical strength than the normal rabbit cornea, but this did not exhibit statistical significance. These results suggest that ADM is a worthy candidate for future exploration as a reinforcement material for peripheral corneal thinning problems.
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ABSTRACT: Abstract The purpose of this study was to analyze the performance of a porcine-derived acellular dermal matrix (Strattice Reconstructive Tissue Matrix) in patients at increased risk for perioperative complications. We reviewed medical records for patients with complex abdominal wall reconstruction (AWR) and Strattice underlay from 2007 to 2010. Intermediate-risk patients were defined as having multiple comorbidities without abdominal infection. Forty-one patients met the inclusion criteria (mean age, 60 years; mean body mass index, 35.5 kg/m(2)). Comorbidities included coronary artery disease (63.4%), diabetes mellitus (36.6%), and chronic obstructive pulmonary disease (17.1%). Fascial closure was achieved in 40 patients (97.6%). Average hospitalization was 6.4 days (range, 1-24 days). Complications included seroma (7.3%), wound dehiscence with Strattice exposure (4.9%), cellulitis (2.4%), and hematoma (2.4%). All patients achieved abdominal wall closure with no recurrent hernias or need for Strattice removal. Patients with multiple comorbidities at intermediate risk of postoperative complications can achieve successful, safe AWR with Strattice.
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