Application of acellular dermal matrix in difficult wounds: 8 case reports and indication revision
Purpose
The mechanism of difficult wound is that the process halted in three phases of wound healing and the treatment of difficult wounds is a relevant social burden. Acellular dermal matrix is cadaveric skin which is prepared with endonuclease and aseptic procedures. It provides wound coverage and an acellular frame for cellular infiltration with vascularization. We will introduce 8 successful cases of difficult wounds which were treated with ADM.
Materials and Method
Our ADM: DermACELL (LifeNet Health, Virginia Beach, VA, USA) is used in all eight cases during May 2017 to Aug. 2018. There are different wound conditions including one chronic ulcer, one diabetic ulcer with gangrene, one arterial ulcer, one necrotizing fasciitis, one insect bite ulcer and three traumatic skin defect. After adequate fasciectomy and sequestrectomy, ADM was applied on the fresh wound surface. In some cases, immediate or delayed split-thickness skin graft was done for the even better result. We record the wound condition on post-operative week 1, 4 and 8.
Results
After 8 weeks observation all wound was healed with well granulation and complete reepithelization and no wound break down was found in our cases during the follow up period (3 to 18 months). All STSG were taken 100% and skin grafts were soft and elastic which provide good function results.
Conclusions
Acellular dermal matrix provides a new method out of traditional wound reconstructive ladder. There are reports that the healing rate using ADM in diabetic ulcer could be up to 80% at 12 weeks, comparing to 24% of standard wound care. It administers adequate wound coverage, framework for cellular infiltration, and decrease the shear tension comparing to traditional local flap or skin graft. Extracellular matrix provides structural support and signals to modulate cellular response. Once the cellular infiltration with well vascularization, the wound is healed with bypassing wound healing phase. Based on our experience, we can put forward revised indication for the ADM on chronic wound treatment.