Abstract
Neoplastic, traumatic, and inflammatory diseases of the oral cavity and oropharynx frequently result in significant defects after resection, also, they may present challenge reconstruction. Regional and distant flaps such as skin grafts (SGs) are routinely used to cover mucosal defects arising from large resections, to restore tissue volume and preserve function. However, there are some disadvantages, mainly related to the donor site morbidity, including pain, risk of infection, occasional hypertrophic scar, and additional contracture resulting from a relative lack of dermis. Therefore, acellular dermal membrane (ADM) seems to be an applicable option to avoid those issues, and it has been shown good results for covering tissue defects. Thus, this study reports the first experience of using the double-layer dermal substitute (DLDS) (NeveliaÒ made by Symatese, France) in oral cavity, to cover and repair a buccal defect, immediately after a large resection of ameloblastoma extending to buccal mucosa. After surgical intervention and actually in follow-up, the patient shows good aesthetic and functional status, 24 months postoperatively. Thus, this DLDS seems to be a good resource in primary buccal reconstruction after extensive tumor resection. However, more studies are needed to be performed.
Highlights
Dermal substitutes such as acellular dermal matrix (ADM) are currently used for the treatment of large skin loss in patients presenting critical general health conditions, including severe burns, and to promote the healing process in chronic wounds
The surgery was conducted by the bucomaxillofacial and plastic surgery clinics. It was utilized a double-layer dermal substitute (DLDS) (Nevelia® Bi-Layer Matrix - Symathese Biomateriaux, Chaponost, France), that consists of a 2mm thick porous reabsorbable membrane made up of glutaraldehyde cross-linked bovine type I collagen with chondroitin-6-sulphate glycosamino- glycan (GAG), and a 2mm thick superior layer of polysiloxane polymer, mechanically reinforced with a polyester fabric
There is a huge development in the field of tissue substitute engineering, intending to improve products designed to assist wound healing, such as ADM or DLDS
Summary
Dermal substitutes such as acellular dermal matrix (ADM) are currently used for the treatment of large skin loss in patients presenting critical general health conditions, including severe burns, and to promote the healing process in chronic wounds. ADM is a soft connective tissue graft generated through a decellularization process that preserves the skin extracellular matrix, acting as a support surface for cells. The bottom side consists of a 3-dimensional collagen structure, which is positioned within the defect, gradually gets incorporated in the wound bed, in a process supported by natural wound-healing mechanisms such as local cell infiltration (neutrophils, macrophages, fibroblasts, and keratinocytes), and neovascularization The set of both layers can be named as acellular bi-layer substitute or double-layer dermal substitute (DLDS). Even when recognizing that this lesion is histologically benign, it behaves as a slow-growing invasive tumor It remains asymptomatic until it reaches a large enough size to provoke bone expansion and perforation of the adjacent soft tissue, at which point the patient may perceive the tumor existence. This study reports the first experience using a DLDS (Nevelia® made by Symatese, France) in oral cavity, intending to cover a buccal tissue defect after extensive resection of an ameloblastoma involving superficial mandibular bone and extending to the jugal mucosa
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