• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.34 no.2
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• pp.220-229
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• 2008

Purpose: The present study was aimed to examine the effect of acellular dermal matrix ($AlloDerm^{(R)}$) grafted to the experimental tissue defect on tissue regeneration. Materials and Methods: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and $AlloDerm^{(R)}$ graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, $AlloDerm^{(R)}$ graft, $AlloDerm^{(R)}$ graft impregnated with rhBMP-2, and $AlloDerm^{(R)}$ graft with rhTGF-${\beta}1$. The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. Results: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of $AlloDerm^{(R)}$ graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of $AlloDerm^{(R)}$ with no satisfactory results in the group of $AlloDerm^{(R)}$ graft. In the groups of the $AlloDerm^{(R)}$ graft with rhBMP-2 or rhTGF-${\beta}1$, there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the $AlloDerm^{(R)}$ with regeneration features. However, the fibrous capsule also remained as in the group of $AlloDerm^{(R)}$ graft, which separated the $AlloDerm^{(R)}$ and the adjacent bone. Conclusions: These results suggest that $AlloDerm^{(R)}$ can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-${\beta}1$.

• Archives of Plastic Surgery
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• v.38 no.5
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• pp.559-566
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• 2011

Purpose: The use of tissue expander/implant in breast reconstruction using tissue expander-implant is one of the most common surgical procedures. The use of AlloDerm as a sling to reestablish the lower pole of the pectoralis major muscle results a decrease in morbidity compared with more invasive procedures. However the use of AlloDerm is more expensive than other options. We decided to compare AlloDerm with Permacol, which has been safely used in human body reconstruction and is less costly than AlloDerm. Methods: After mastectomy, the inferolateral origin of the pectoralis major muscle was elevated. Either AlloDerm or Permacol was sutured to the chest wall at the level of the previously marked inframammary fold. The lower border of the pectoralis major muscle and the upper portion of the crescent-shaped piece of either AlloDerm or Permacol was sutured together using a tension free technique, and a tissue expander was subsequently inserted into the subpectoral-subAlloDerm (or Permacol) dual pocket. Results: AlloDerm was used in twenty-one patients (28 breasts) and Permacol was used in six patients (11 breasts) for tissue expander-implant breast reconstruction. During the mean follow-up period of 17 months (8~25 months). Two infections (7%) occurred in AlloDerm cases and four infections (36%) occurred in Permacol cases. Conclusion: This study is the first comparison of tissue expander/implant breast reconstruction using AlloDerm and Permacol. The use of Permacol resulted in more postoperative infection compared with the use of AlloDerm. This report is still limited with the small number of cases studied.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.30 no.1
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• pp.1-10
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• 2008

Purpose: This study was aimed to examine the resorption rate, the healing pattern, and the response of the surrounding tissue after the graft of the acellular dermal matrix ($AlloDerm^{(R)}$) and the autogenous dermis, and to report the clinical result of the use of $AlloDerm^{(R)}$ in order to restore the soft tissue defects. Methods: Twenty mature rabbits, weighing about 3 ㎏, were used for the experimental study. The $10\times10$ mm-size autogenous dermis and the $AlloDerm^{(R)}$ were grafted to the space between the external abdominal oblique muscle and the fascia of the rabbits. And the $AlloDerm^{(R)}$ was grafted to the pocket between the skin and the underlying perichondrium of rabbit ear. The resorption rate of the grafted sites was calculated, and the tissue specimens were histologically examined at 1, 2, 4, and 8 weeks after the graft. The five patients with the cleft-lip nasal deformity and the one patient with the saddle nose deformity, who received the $AlloDerm^{(R)}$ graft to restore the facial soft tissue defects, were reviewed for the clinical study. Results: The resorption rate at 8 weeks after the graft was 21.5% for the autogenous dermis, and 16.0% $AlloDerm^{(R)}$. In microscopic examinations, the infiltration of the inflammatory cells and the epidermal inclusion cyst were observed in the autogenous dermis graft. However, the neovascularization and the progressive growth of the new fibroblasts were shown in the $AlloDerm^{(R)}$ graft. And the six patients, who received the $AlloDerm^{(R)}$ graft, demonstrated the good stability of the grafts and improved appearance. There were no remarkable complications such as inflammation, rejection, dislocation, and severe absorption in the clinical cases. Conclusion: These results suggest that $AlloDerm^{(R)}$ can be an useful graft material for restoration of soft tissue defects because of the good stability and the tissue response without the remarkable clinical complications.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.31 no.3
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• pp.216-221
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• 2009

Purpose: The retention of the basement membrane complex, which was the unique feature of the acellular dermal matrix ($AlloDerm^{(R)}$), plays an important role in the normal process of wound healing. The present study was aimed to compare the healing of the acellular dermal matrix according to the graft method in the rabbit ear. Materials and methods: Six mature rabbits weighing about 3.0 kg were used, $10\;{\times}\;5\;mm$ sized subcutaneous pockets were created between the ear skin and the underlying perichondrium. In the control group, the acellular dermal matrix was grafted with the basement membrane facing toward the perichondrium. On the contrary, the acellular dermal matrix was grafted with the basement membrane facing toward the skin side in the experimental group I. In the experimental group II, the acellular dermal matrix was grafted like rolled configuration with basement membrane side in. The grafted site was picked at 3, 7, and 21 days after the graft. Serial sections were processed by H-E stain and examined under light microscopy to assess the healing patterns. Results: There was no distinct volume loss in the gross examination, but resorption was observed from the edge of the acellular dermal matrix in the histological examination. The space of resorption was replaced by the newly formed fibrous tissues and vessels. The inflammatory cells were more increased at 7 days after the graft than the early days. However, inflammation was decreased at 21 days after the graft. Regardless of the graft direction, no differences were observed between the control and the experimental group I in the healing patterns. Conclusion: These results suggest that the acellular dermal matrix can be used simply and effectively without regard to the graft direction as a substitute of autogenous material for repairing soft tissue defect.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.578-582
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• 2009

Purpose: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to success, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one - stage operation on bone exposed soft tissue defect with AlloDerm$^{(R)}$(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. Methods: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm$^{(R)}$(25 / 1000 inches, meshed type) was applicated on wound, and thin split thickness(6 ~ 8 / 1000 inches) skin graft was done at the immediately same operative time. Results: Average age of patients was 53.6 years(25 years ~ 80 years, SD = 16.8), and 13 patients were male(male : female = 13 : 1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site. (tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm$^{(R)}$ took without additional surgery in 12 of 14 patients. Partial graft loss was shown on four cases. Two cases were small in size under $1{\times}1cm$, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm$^{(R)}$ was enough. Average duration of admission period of patients without additional surgery was 15 days(13 ~ 19 days). Conclusion: AlloDerm$^{(R)}$ and thin split thickness skin graft give us an advantage in short surgery time and less limitations in donor site than flap surgery. Postoperative scar is less than in conventional skin graft because of more firm restoration of dermal structure with AlloDerm$^{(R)}$. We propose that AlloDerm$^{(R)}$ and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

• Archives of Reconstructive Microsurgery
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• v.15 no.2
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• pp.92-100
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• 2006

Radial forearm free flap (RFFF) has been established itself as a versatile and widely used method for reconstruction of the head and neck, although it is still criticized for high mortality of donor site. Delayed wound healing, cosmetic deformity, vascular compromise and potentially reduced wrist function have many plastic surgeons hesitate to adapt it as a first choice in micro-reconstruction. To overcome these drawbacks, some techniques for donor-site repair such as V-Y advancement with full thickness skin graft (FTSG), application of artificial dermis ($Terudermis^{(R)}$) or acellular dermal matrix ($AlloDerm^{(R)}$), and double-opposing rhomboid transposition flap have been reported. Authors performed 4 cases of RFFF in old-aged patients of the head and neck cancer from April 2005 to February 2006. We compared the outcomes of donor site of RFFF which were resurfaced with split thickness skin graft (STSG) only and STSG overlying an $AlloDerm^{(R)}$. Patients were all males ranging from 59 to 74 years old (mean, 67.5). Three of them had tongue cancers, and the other showed hypopharyngeal cancer. All cases were pathologically confirmed as squamous cell carcinomas. We included the deep fascia into the flap, so called subfascially elevated RFFF in three cases, and in the other one, we dissected the RFFF suprafascially leaving the fascia intact. The donor site of the suprafascially elevated RFFF was resurfaced with STSG only. Among three of subfascially elevated RFFFs, donor-sites were covered with thin STSG only in one case, and STSG overlying $AlloDerm^{(R)}$ in two cases. All RFFFs were survived completely without any complication. The donor site of the suprafascially elevated RFFF was taken well with STSG only. But, the partial graft loss exposing brachioradialis and flexor carpi radialis muscle was unavoidable in all the subfascially elevated RFFFs irregardless of $AlloDerm^{(R)}$ application. Considering that many patients of the head and neck cancer are in old ages, we believe the RFFF is still a useful and versatile choice for resurfacing the head and neck region after cancer ablation. Its reliability and functional characteristics could override its criticism for donor site in old-aged cancer patients.