Acellular Dermal Matrix Allograft Research Articles

Surgical Treatment of Insertional Achilles Tendinopathy Augmented With Human Acellular Dermal Matrix: A Retrospective Case Series

Background: Insertional Achilles tendinopathy (IAT) is often surgically treated with Achilles tendon partial or total detachment, debridement and repair of the Achilles tendon, excision of retrocalcaneal exostosis, and suture anchor reattachment. To date, there is no report that examines the use of acellular dermal matrix (ADM) augmentation in this procedure without the use of suture anchor reattachment. Methods: Thirty-two female and 10 male patients (mean age 52 years) with IAT underwent surgical treatment including partial detachment of the Achilles tendon, excision of the retrocalcaneal exostosis, debridement and repair of the Achilles tendon, and augmentation with human acellular dermal matrix allograft. Outcomes measured were the visual analog scale (VAS) score, time to weightbearing, major and minor complications. Results: Forty-two patients were followed for a mean of 20.8 months. The VAS score improved from a mean of 5.1 to 1.9 at final follow-up. The mean time to weightbearing was 4.4 weeks. Eleven patients (26.2%) experienced complications. One patient (2.4%) suffered a rupture of the Achilles in the early postoperative period. Three patients (7.1%) had delayed wound healing, with 1 (2.4%) requiring surgical debridement. Two (4.8%) experienced continued pain requiring further surgical treatment. Conclusion: This protocol for surgical treatment of IAT with the use of human ADM allograft augmentation resulted in improved VAS scores and was associated with a low risk of postoperative infection without a prolonged nonweightbearing period. Level of Evidence: Level IV, retrospective case series.

Evaluation of Tibiofemoral Contact Mechanics After a Novel Hybrid Procedure for Femoral Osteochondral Defect Repairs With a Subchondral Implant and Dermal Matrix.

There is a lack of procedures that adequately address the subchondral bone structure and function for reconstructing osteochondral defects in the femoral condyles. To biomechanically evaluate the tibiofemoral joint contact characteristics before and after reconstruction of femoral condylar osteochondral defects using a novel hybrid reconstructive procedure, which was hypothesized to restore the contact characteristics to the intact condition. Controlled laboratory study. Tibiofemoral contact areas, contact forces, and mean contact pressures were measured in 8 cadaveric knees (mean age 52 ± 11 years; 6 women, 2 men) using a custom testing system and pressure mapping sensors. Five conditions were tested for each condyle: intact, 8-mm defect, 8-mm repair, 10-mm defect, and 10-mm repair. Medial femoral condylar defects were evaluated at 30° of knee flexion and lateral condylar defects were evaluated at 60° of knee flexion, with compressive loads of 50, 100, and 150 N. The defects were reconstructed with a titanium fenestrated threaded implant countersunk in the subchondral bone and an acellular dermal matrix allograft. Repeated-measures analysis of variance with Bonferroni correction for multiple comparisons was used to compare the results between the 5 testing conditions at each load. Medial condylar defects significantly increased mean contact pressure on the lateral side (P < .042), which was restored to the intact levels with repair. The lateral condylar defect decreased the mean contact pressure laterally while increasing the mean pressure medially. The lateral and medial mean contact pressures were restored to intact levels with the 8-mm lateral condylar defect repair. The medial mean contact pressure was restored to intact levels with the 10-mm lateral condylar defect repair. The lateral mean contact pressure decreased compared with the intact state with the lateral condylar 10-mm defect repair. Tibiofemoral joint contact pressure was restored to the intact condition after reconstruction of osteochondral defects with dermal allograft matrix and subchondral implants for the repair of both 8- and 10-mm lateral condylar defects as well as 8-mm medial condylar defects but not completely for 10-mm medial condylar defects. The novel hybrid procedure for osteochondral defect repair restored tibiofemoral joint contact characteristics to normal in a cadaveric model.

Surgical Management of Massive Irreparable Cuff Tears/Management of Rotator Cuff Disease: Interpositional Graft for Irreparable Posterosuperior Rotator Cuff Tears.

Increasingly, massive irreparable rotator cuff tears present a treatment challenge due to their high re-tear rates. The reparability of such tears depends on factors like tear size, the number of involved tendons, tendon retraction extent, muscular atrophy, fatty infiltration, and the presence or absence of arthritis. There are non-surgical and several surgical treatment options described each with their specific indications, contraindications, pros, and cons. Bridging reconstruction restores the superior rotator cuff tissue and arrests humeral head superior migration. The purpose of his review is to explore the existing literature on interpositional graft mechanics, indications, surgical technique, and clinical outcomes. It aims to understand how these parameters can facilitate the incorporation of bridging reconstruction using interpositional grafts into a surgeon's practice for managing massive irreparable rotator cuff tears. Interpositional grafts for irreparable massive rotator cuff tears can either be auto-, allo-, xenografts, or synthetic material and are best suited for patients who are relatively younger, no glenohumeral arthritis, and minimal to no fatty infiltration and muscle atrophy. Short to medium term outcome studies available report good functional, clinical, and radiological improvements with bridging reconstruction utilizing acellular dermal matrix allograft. Interpositional grafts for management of irreparable posterosuperior cuff tears provides improved clinical and radiological outcomes with minimal complications and thus a viable and valuable surgical technique for a shoulder surgeon's armamentarium.

Analysis of Abduction Moment Arms after Rotator Cuff Tear and Acellular Dermal Matrix Allograft Reconstruction.

Biomechanical testing of abduction moment arms presents a useful method to assess the contribution of individual rotator cuff muscles to glenohumeral function. This study aimed to investigate the changes in abduction moment arms after a supraspinatus tear treated with Superior Capsule Reconstruction (SCR), Bursal Acromial Reconstruction (BAR), and a combined SCR-plus procedure, all with human dermal allograft. 7 fresh-frozen cadaveric specimens were tested in 6 conditions: (1) intact, (2) 50% supraspinatus tear (partial tear), (3) 100% supraspinatus tear, (4) SCR, (5) SCR+BAR, (6) BAR. In each condition, moment arms for the individual muscles of teres minor, subscapularis, and infraspinatus were calculated throughout 90º of abduction using Optotrak motion capture. ANOVA and post-hoc Tukey testing were performed to determine significance. In teres minor, the moment arms of the SCR (11.92mm), BAR (10.05mm), and SCR+BAR (11.87mm) conditions were greater than those in the intact (8.51mm, p=0.001, p=0.001, p=0.001, respectively), partial tear (9.09mm, p=0.001, p=0.128, p=0.001, respectively), and complete tear (8.75mm, p=0.001, p=0.011, p=0.001, respectively) conditions. Similarly in subscapularis, moment arms in the SCR (13.36mm), BAR (13.84mm), and SCR+BAR (13.53mm) conditions were greater than those in the intact condition (10.59mm, p=0.006, p=0.001, p=0.003, respectively) and partial tear condition (10.43mm, p=0.006, p=0.001, p=0.003, respectively). In teres minor, SCR (11.92mm) and SCR+BAR (11.87mm) were also found to have significantly increased moment arms compared to BAR (10.05mm, p=0.001, p=0.001, respectively). In Infraspinatus, BAR (13.77mm) was found to have a significantly decreased moment arm compared to the partial tear condition (15.78mm, p=0.026), with no other significant findings between conditions. These results suggest that the moment arm contributions from individual muscles comprising the rotator cuff can change after reconstruction to compensate for tears. SCR and SCR+BAR increase moment arms in teres minor and subscapularis, potentially allowing for increased abduction ability.

Evaluation of hyaluronic acid gel with or without acellular dermal matrix allograft in the treatment of class II furcation defects in dogs: A histologic and histomorphometric study

AimTo evaluate the histologic and histomorphometric effects of hyaluronic acid (HA) gel with or without acellular dermal matrix allograft (ADMA) on periodontal regeneration in Class II furcation defects in dogs. Materials and methodsClass II furcation defects were surgically created in the mandibular first and second premolars bilaterally in eight beagle dogs. The Class II furcation defects were assigned randomly, using the split-mouth design, into the test and control sides. The teeth on the test sides were equally and randomly divided into the HA/ADMA group (n = 8) treated with 0.8% HA gel followed by ADMA, and the HA-only group (n = 8) treated with 0.8% HA only. The furcation defects of the control sides (n = 16) were subjected to open flap debridement (OFD group). The animals were euthanized for histologic and histomorphometric analyses after one month (n = 4) and three months (n = 4). ResultsAt one month, the newly formed bone area (NFBA) was larger in the HA/ADMA (6.23 ± 1.41 mm2) and HA-only (5.90 ± 1.43 mm2) groups than in the OFD group (2.42 ± 1.62 mm2) (p < 0.05). The newly formed cementum (NFAC) and periodontal ligament (NFPL) were similar in the HA/ADMA and HA-only groups but significantly lesser in the OFD group (p < 0.05.) At three months, the NFBA, NFAC, and NFPL were greater in the HA/ADMA group than in the HA-only group (p < 0.05). New regenerative tissue was significantly greater in both the test groups than in the OFD group (p < 0.05), while epithelial downgrowth predominated the healing in the latter. ConclusionsThese results suggest that HA with ADMA positively affects the periodontal regeneration and wound healing in Class II furcation defects.

Postoperative Graft Volume Reduction Is Associated With Inferior Clinical Outcomes of Superior Capsule Reconstruction Using an Acellular Dermal Matrix Allograft

To evaluate whether postoperative graft volume reduction is associated with clinical outcomes after superior capsule reconstruction (SCR) and to identify factors related to graft volume change. Between May 2018 and June 2021, patients who underwent SCR with acellular dermal matrix allograft for irreparable rotator cuff tear with a minimum 1-year follow-up and who had intact graft continuity in postoperative 6-month magnetic resonance imaging were retrospectively reviewed. The lateral half to the medial half of the graft volume ratio was defined as lateral half graft volume ratio. The difference between the preoperative and postoperative lateral half graft volume ratio was defined as lateral half graft volume change. Patients were divided into 2 groups: those with preserved graft volume (group I) and those with reduced graft volume (group II). Intergroup differences in clinical and radiological characteristics were analyzed. A total of 81 patients were included, with 47 (58.0%) in group I and 34 (42.0%) in group II. Group I showed significantly lower lateral half graft volume change (0.018 ± 0.064 vs 0.370 ± 0.177; P < .001) than group II. Group II showed significantly greater preoperative Hamada grade (1.3 ± 0.5 vs 2.2 ± 0.6, P < .001), an anteroposterior distance of the graft at the greater tuberosity (APGT) (30.3 ± 4.8 vs 35.2 ± 3.8, P < .001), and fatty infiltration of infraspinatus (2.3 ± 0.9 vs 3.1 ± 0.8, P < .001) and subscapularis (0.9 ± 0.9 vs 1.6 ± 1.3, P= .009) than group I. Group II had a significantly lower proportion of patients achieving MIC in Constant score than group I (70.2% vs 47.1%, P= .035). The Hamada grade, APGT, and fatty infiltration of infraspinatus and subscapularis were independent factors of graft volume change. Although SCR improved pain and shoulder function, postoperative graft volume reduction was related to a lower rate of minimal important change achievement in the Constant score compared with preserved graft volume. The preoperative Hamada grade, APGT, and fatty infiltration of infraspinatus and subscapularis were associated with graft volume reduction. Level III, retrospective case-control study.

Outcome of intraoperative injection of collagen in arthroscopic repair of full-thickness rotator cuff tear: a retrospective cohort study

Rotator cuff (RC) pathologies are considered the most common cause of shoulder disability and pain. Arthroscopic repair of RC tears has proven to be an effective operation. Nonhealing and retear remain significant clinical problems and a challenge to surgeons. In addition, the essential biological augment to enhance RC tendon-bone healing is still under research. The purpose of the study was to assess the safety and efficacy of injection of atelocollagen and acellular dermal matrix (ADM) allograft in arthroscopic repair of full-thickness RC tears. From January 2018 to March 2020, a total of 129 patients with full-thickness RC tear were treated by arthroscopic repair only (group 1, n=36, with a mean age=63.2 years), arthroscopic repair together with atelocollagen 1-mL injection (group 2, n=44, with a mean age=63 years), or RC tears together with ADM allograft 1-mL injection (group 3, n=49, with a mean age=64.6 years). They were prospectively studied. This study included patients with a repairable full-thickness tear of the supraspinatus tendon size <5 cm. We excluded patients with isolated tears of the subscapularis tendon, those with a previous shoulder surgery, and those who had any type of injection for less than 6 weeks. American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form score, Constant Shoulder score, visual analog scale pain score, and range of motion were evaluated preoperatively, at 3, 6, and 12 months of the postoperative period and the final follow-up. In addition, magnetic resonance imaging was performed at 2 months and 12 months postoperatively. The mean follow-up period was 20 months. All groups showed improvement in functional and pain score at the final follow-up; however, there is no superior outcome among the 3 groups (P>.05). After 2 months, the nonhealing rate was 11% (4 of 36) for group 1, 4% (2 of 44) for group 2, and 2% (1 of 49) for group 3 (P>.05). The retear rates after 12 months was 19.4% (7 of 36) for group 1, 13.6% (6 of 44) for group 2, and 20.4% (10 of 49) for group 3 (P>.05). Adverse events were not detected in any groups. Our study did not show superior clinical or radiologic outcomes of atelocollagen and ADM allograft injections in arthroscopic RC repair over 12 months of follow-up in comparison to the control group. However, adverse events related to atelocollagen and ADM allograft injection were not observed.

Superior Capsule Reconstruction Using an Acellular Dermal Matrix Allograft Combined With Remnant Tendon Augmentation for Irreparable Rotator Cuff Tear

Graft fixation sites on the greater tuberosity and the superior glenoid for superior capsule reconstruction (SCR) are prone to graft failure. The graft fixation procedure on the superior glenoid is challenging due to the limited working space, narrow graft attachment site, and difficulties in suture management. This technical note introduces the surgical technique of SCR using an acellular dermal matrix allograft combined with remnant tendon augmentation to enhance graft healing and the suture management technique to prevent suture tangling for the treatment of irreparable rotator cuff tear.

Treatment of gingival class I or class II recession using subepithelial connective tissue graft and acellular dermal matrix allograft.

The present randomized control was conducted clinically to evaluate the effectiveness of Acellular Dermal Matrix Allograft (ADMA) and Subepithelial Connective Tissue Graft (SCTG) in combination with Coronally Positioned Flap (CPF) in the treatment of Miller's class I and II multiple gingival recession in aesthetic areas. A total of 20 patients aged between 18 to 40 years were selected for this study, meeting all the criteria for inclusion. 10 patients were treated with ADMA and 10 patients with SCTG in combination with CPF. Various clinical parameters were assessed viz. probing pocket depth (PPD), clinical attachment level (CAL), gingival recession height (RH) and width of keratinized gingiva (WKG) at baseline and 6 months after surgery. The mean RH at baseline in the control and test groups was 3.05 ±0 .55(mean± SD) and 2.60 ±.99 respectively. At 3 months the mean RH was found to be 1.60±0.74 and 1.05 ± .60 in the control and test group respectively. The mean percentage of root coverage (MRC%) at 6 months in the control and test group was 65.69 ±26.52 (mean± SD) and 65.54 ±.9.16 respectively but no statistically significant difference was seen between the two groups. The results of the study suggest that the combination of both subepithelial connective tissue graft and acellular dermal matrix graft with a coronally positioned flap can produce an equivalent amount of esthetic root coverage.

Unusual complications at the recipient site following periodontal plastic surgery procedures: a systematic review.

To identify and describe unusual soft tissue complications of periodontal plastic surgery procedures at the recipient site after periodontal grafts. Two independent reviewers performed a comprehensive search in MEDLINE, Cochrane, periodontics journals, reference lists, and grey literature for articles dated up to July 2021. Publications related to surgical interventions only around the teeth with an unusual complication at the recipient site were selected. No restrictions were made in the number of cases, follow-up period, or language. The Cochrane Collaboration's tool for assessing risk of bias, the Newcastle-Ottawa Scale (NOS), and two validated case report/series checklists were used to critically appraise the studies. A total of 1434 articles were examined, of which 28 met the inclusion criteria: one RCT, two cohort studies, and twenty-five case reports/series. The periodontal plastic surgery procedures described in these articles were conducted to treat lack of attached gingiva and gingival recessions. The following unusual complications were found: bone exostosis, epithelial inclusion, root resorption, abscess, overgrowth, "liver clot" formation, and oroantral communication. Bone exostosis and epithelial inclusions were the most prevalent unusual complications following treatment with subepithelial connective tissue graft, free gingival graft, and acellular dermal matrix allograft. Due to the nature of the reports, the clinical recommendations for diagnosis and treatment cannot be homogenized. Clinical studies reporting complications are required to develop management protocols (PROSPERO CRD42021230875). Clinicians need to know the main complications that can occur in mucogingival surgeries as well as their clinical management to provide a successful and predictable treatment.

Tear pattern after superior capsular reconstruction using an acellular dermal matrix allograft.

The healing rate and tear pattern of grafts in superior capsular reconstruction (SCR) using acellular dermal matrix (ADM) allograft are poorly understood, and clinical results based on the graft status remain controversial. Fifty-one consecutive patients undergoing arthroscopic SCR with ADM between October 2017 and February 2020 were enrolled. Range of motion, strength, and the visual analog scale pain (PVAS) score, American Shoulder and Elbow Surgeons (ASES) score, and Constant score were evaluated preoperatively and at the last follow-up. Postoperative magnetic resonance imaging was performed in all patients and was obtained at least 6 months (mean, 8.9±3.6 months) after surgery. The graft tear status was analyzed on magnetic resonance imaging, and the numbers of patients who achieved the minimal clinically important difference and patient acceptable symptomatic state were analyzed to determine the differences in outcome according to graft tear status. The range of motion and clinical results improved at a minimum of 1 year (mean, 18±5.4 months), whereas strength in forward flexion and external rotation did not (P=.676 and P=.995, respectively). The graft was intact in 36 of 51 patients (70.6%), 9 patients (17.6%) showed an incomplete graft tear with maintained continuity (partial graft rupture at 1 anchor on either the glenoid or humeral side), and 6 patients (11.8%) showed complete graft rupture (5 on the glenoid side and 1 on the humeral side). In cases with a tear (either incomplete or complete), the odds of achieving the minimal clinically important difference for the PVAS score (P=.047) and ASES score (P=.020) was significantly lower than that of the intact graft. However, when the continuity of the graft was maintained, even in cases with a partial tear, patients who reached the patient acceptable symptomatic state showed significantly higher odds for the PVAS score and trends for the ASES score. After SCR using ADM, the graft status could be classified as intact, an incomplete graft tear (where the continuity between the glenoid and humerus was maintained), or an complete tear. When the graft continuity was maintained, even in incomplete graft tears, patients were generally satisfied with postoperative pain and function at 1 year following SCR.

An advanced decellularized dermis intended for soft tissue repair: A new surgical approach for DFU

Skin substitutes are heterogeneous group of biological and/or synthetic elements that enable the temporary or permanent occlusion of wounds. Although dermal substitutes can vary from skin xenografts or allografts to a combination of autologous keratinocytes over the dermal matrix, their common objective is to achieve the greatest possible similarity with the patient’s skin The acellular dermal matrix allows the body to rebuild its own strong tissue without the need for alloplastic material. The three-dimensional collagen will be replaced by vital new tissue. An alternative treatment for diabetic foot ulcers is a matrix scaffold for new tissue generation, an acellular human dermal matrix (ADM) allograft. Decellularized human skin has been used for a variety of medical procedures, primarily involving wound healing, soft tissue reconstruction, and sports medicine applications.

Radiocapitellar Contact Characteristics After Osteochondral Defect Repair Using a Novel Hybrid Reconstructive Procedure

Background:Many procedures to reconstruct osteochondral defects of the elbow radiocapitellar (RC) joint lack versatility or durability or do not directly address the subchondral bone structure and function.Purpose/Hypothesis:To biomechanically characterize the RC joint contact area, force, pressure, and peak pressure before and after reconstruction of osteochondral defects using a novel hybrid reconstructive procedure. It was hypothesized that the procedure would restore the contact characteristics to the intact condition.Study Design:Controlled laboratory study.Methods:A total of 10 cadaveric elbows (mean age 67 ± 2.7 years) were dissected to isolate the humerus and radial head. RC contact area, contact force, mean contact pressure, and peak contact pressure were measured with the elbow at 45° of flexion and neutral forearm rotation at compressive loads of 25, 50, and 75 N. Osteochondral defects 8 and 11 mm in diameter were created at the center of the capitellum; the defects were then reconstructed with a titanium fenestrated threaded implant, countersunk in the subchondral bone, with an acellular dermal matrix allograft sutured in place on top of the implant. Five conditions (intact, 8-mm defect, 8-mm repair, 11-mm defect, and 11-mm repair) were tested and results were compared using repeated-measures analysis of variance.Results:Both 8- and 11-mm defects significantly increased RC mean contact pressure at all compressive loads (P ≤ .008) and significantly increased peak contact pressure at compressive loads of 50 and 75 N (P < .002) compared with the intact condition. Repair of the 8-mm defect significantly decreased RC mean contact pressure at 25- and 50-N loads (P ≤ .009) and significantly decreased peak contact pressure at 50- and 75-N loads (P ≤ .035) compared with the defect condition. Repair of the 11-mm defect decreased mean contact pressure significantly at all compressive loads (P ≤ .001) and peak contact pressure at 50- and 75-N loads (P < .044) compared with the defect condition.Conclusion:RC joint contact pressure was restored to intact conditions while avoiding increased peak contact pressure or edge loading after repairing osteochondral defects related to osteochondrosis with a novel hybrid reconstruction technique.Clinical Relevance:This hybrid procedure that addresses the entire osteochondral unit may provide a new treatment option for osteochondral defects.

Clinical evaluation of root coverage using coronally positioned flap associated with acellular dermal matrix allograft in single-type recession defects. A retrospective study.

The aim of this study was to conduct a retrospective assessment of the clinical results at 6,12 and 24 months of root coverage in single gingival recessions using coronally positioned flap and acellular dermal matrix allograft. Clinical records were collected from 16 patients with single gingival recessions who visited a private practice in Periodontics in 2005 and 2006. They were treated through a coronally positioned flap and acellular dermal matrix allograft. The following periodontal parameters were recorded at baseline, 6, 12 and 24 months: Recession Depth, Recession Width, Probing Depth, Clinical Attachment Level, Keratinized Tissue Width, Plaque Index, Gingival Index and Sensitivity. The percentage of root coverage was 91.18 ± 21.26 at 6 months, 90.18 ± 22.04 at 12 months and 90.83 ± 18.41 at 24 months. Complete root coverage was 81% (13 out of 16) at 6 and 12 months. At 24 months, complete root coverage was 75% (9 out of 12). The plaque and gingival indexes did not vary significantly between baseline and measurement times. Probing depth was maintained at healthy levels during the months of follow-up. Sensitivity decreased at 12 months (4 of 16) compared to baseline (14 of 16), and was maintained at 2 years (2 of 12). This retrospective study showed that acellular dermal matrix allograft could be considered a useful alternative for the treatment of single gingival recessions, reducing the discomfort and morbidity associated with the palatal donor site.

Histologic case series of human acellular dermal matrix in superior capsule reconstruction.

Acellular dermal matrix (ADM) allografts are commonly used in the surgical treatment of complex and irreparable rotator cuff tears. Multiple studies report that superior capsule reconstruction (SCR) using ADM has resulted in short-term clinical success as assessed via radiographic and patient-reported outcomes. However, limited information is available regarding the biologic fate of these grafts in human subjects. This case series describes histologic results from 8 patients who had reoperations, during which the previously implanted ADMs were removed. These explanted ADMs were subjected to histologic analysis with the hypothesis that they would have evidence of recellularization, revascularization, and active remodeling. Eight patients, 38-82 years old, underwent reoperation 6-38 months after undergoing SCR. ADM explants were voluntarily shipped to the manufacturer for histologic analysis. Each graft's structure and composition were qualitatively evaluated by 1 or more of the following histologic stains: hematoxylin and eosin, safranin O, and Russell-Movat pentachrome. Pan-muscle actin staining also assessed the level of neovascularization, potential myoblast or myocyte infiltration, and muscle tissue development in the graft, and was analyzed to determine the proportion of graft that had been recellularized in situ. Grafts showed varying levels of gross and microscopic incorporation with the host. An uneven, but high, overall degree of recellularization, revascularization, and active remodeling was observed. The degree of remodeling correlated with implant duration. These results are consistent with successful biologic reconstruction of the superior shoulder capsule. The present histologic analysis suggests that ADMs used in SCR undergo active recellularization, revascularization, and remodeling as early as 6 months after implantation, and that graft recellularization positively correlates with duration of implantation. These results represent a significant advancement in our knowledge regarding biologic incorporation of ADMs used in SCR.

Relapses of traumatic peroneal tendons subluxation already treated surgically: a new surgical approach.

Aim To illustrate the surgical treatment of relapses of traumatic peroneal tendons subluxation. Methods We came across a young woman, who sustained a sprain in her dominant ankle after a trauma; we noticed subluxation of the peroneal tendons during eversion and extension of the foot. She referred to a previous accident some years before with peroneal tendon subluxation treated by superior peroneal retinaculum (SPR) sutures with a synthetic braided absorbable material. We prescribed conventional radiography, magnetic resonance imaging (MRI) and performed surgery: we removed scar tissue, reattached the retinaculum using suture anchors strengthening it with an acellular dermal matrix allograft patch. Results Periodic clinical follow-ups until 24 months were performed evaluating the stability of the ankle, checking the range of movement, and the Visual Analogic Scale (VAS) and American Orthopedic Foot and Ankle Society Score (AOFAS) was administered. At the first check the subluxation was resolved and the ankle was stable. The VAS scale had the value of 0 at the 3-month follow-up maintained until the final check. Conclusion Relapsing traumatic peroneal tendons subluxation is rare, as well as the possibility of a re-intervention years later. This technique seems to guarantee an excellent result even in the long term, allowing resolution of pain and joint stability. In fact, the use of acellular dermal patch is an already commonly described technique for the augmentation in rotator cuff and hip capsular repair; no reports are available in literature in relation to the use of graft for the repair of the superior peroneal retinaculum.

Comparison of acellular dermal matrix allografts and connective tissue autografts in soft-tissue augmentation around immediate implants: A pilot study

BackgroundImmediate implant has multiple advantages but does not prevent the reduction in dimension of the labial cortical plate due to bone remodelling and soft-tissue collapse along with gingival recession. This Randomised Controlled Trial (RCT) was carried out to evaluate the changes in peri-implant soft-tissue dimensions after the immediate implant along with soft-tissue augmentation with acellular dermal matrix and connective tissue autografts. MethodsTwenty clinical cases requiring tooth extraction in the anterior region of the maxilla (single rooted tooth) were selected and randomly divided. An immediate implant with soft-tissue augmentation with acellular dermal matrix (group A) and connective tissue autografts (group B) was carried out. Clinical parameters such as thickness of the marginal gingiva (mm), width of the keratinized mucosa (KMW) (mm), dimensions of the interdental papilla between the implant and the adjacent teeth (mesial and distal) and gingival biotype around the implant at the baseline (before extraction of the tooth) and at 180 days (after implant placement during second-stage surgical exposure) were evaluated. ResultsThe mean postoperative gingival thickness and KMW were statistically higher in group B than in group A. There was statistically significant intragroup decrease in papillary height in both the groups; however, intergroup change was insignificant. In both the groups, there was an increase in thickness of gingival tissue, but the gingival biotype remained thin. ConclusionImmediate implants augmented with connective tissue autografts showed an increase in thickness of the gingiva and KMW, reduced papillary collapse and improvement in tissue biotype as compared with the acellular dermal matrix.

Nasal Septal Perforation Repair with an Inferior Turbinate Flap and Acellular Dermal Matrix.

Nasal septal perforation is an uncommon disorder that can cause disturbance of nasal physiology. The perforations can vary widely in size, location, and symptomatology. Many different closure techniques have been described in the literature; however, no gold standard has been recognized. The choice of surgical technique usually depends on the characteristics of the perforation and surgeon experience. Due to the goal of perforation repair being restoration of normal nasal physiology, techniques with the best outcomes have been those resurfacing the septum with nasal respiratory mucosa. Here we present our novel surgical method for large (> 2 cm) septal perforation closure using a modification of the inferior turbinate flap repair using a polydioxanone plate and the acellular dermal matrix allograft (Alloderm, Allergan Inc.).

Clinical efficacy of xenogeneic and allogeneic 3D matrix in the management of gingival recession: a systematic review and meta-analysis.

A systematic review and meta-analysis was thus conducted to answer the following focused question based on PICO strategy: Is there any 3D matrix biomaterial used for root coverage of human Miller class I and II defects equivalent with the connective tissue graft in localized defects of at least 2mm and 3mm? The search on electronic database included MEDLINE, Cochrane Central Register of Controlled Trials, Clinical Trials.gov, Web of Science, and New Zealand/Australian Clinical Trials. Only randomized clinical trials (RCTs) that compared connective tissue graft (CTG) with at least one 3D matrix alone for root coverage in Class I and II Miller localized defects of at least 2mm, with at least 6months follow-up, were included in this systematic review. A total of 14 studies were included for meta-analysis (12 compared CTG with acellular dermal matrix allograft and 2 compared CTG with Xenogenic Collagen Matrix). Relative root coverage showed no significant difference among the materials, for either 2 or 3mm minimal recessions. For keratinized tissue width, on 2mm recessions, CTG showed superiority above other biomaterials, but on 3mm recessions, it seemed to have the same results. The percentage of recessions with complete root coverage for both 2 and 3mm recessions showed similar results for all biomaterials. With their limits, the present data concluded that CTG, acellular dermal matrix allograft, and xenogenic collagen matrix provided similar results for root coverage. To know if there is a 3D matrix with equivalent predictable results for root coverage, that we could avoid the morbidity of the connective tissue graft for these cases.

Human Acellular Dermal Matrix Augmentation Phalloplasty Surgery

Many men often have the need to enlarge their penises for psychological gain and to satisfy or to impress their partners. Many surgical techniques have been reported. However, none is the gold standard. To evaluate the efficacy and safety of human acellular dermal matrix allograft in augmentation phalloplasty technique. From March 2015 to September 2017, a total of 182 patients were prospectively recruited into our cohort after complete physical and psychological evaluation that deemed suitable for penile enhancement. Penis circumference was measured at the mid-length of the penis. Mean was 7.03 cm (6.93 ± 1.00 cm) and 12.1 cm (10.59 ± 1.15 cm) during flaccid and erection, respectively. All patients received human acellular dermal matrix graft under spinal or local anesthesia. The allograft was preconditioned in normal saline for 20 minutes, and mesh incisions were made to optimize blood flow. The width was equal to the circumference of both corpus cavernosa but without corpus spongiosum. The length of the graft was determined by measuring the length between the tip of the coronary sulcus and the root of penis. A complete incision below the coronary sulcus to the depth of the Buck's fascia was made. Then separate the dartos fascia from the Buck's fascia. The prepared graft was then placed on top of the Buck's fascia, with the blood-remained side facing the Buck's fascia. The graft was sutured using 4-0 absorbable polyglycolic acid suture to the Buck's fascia. Extra caution needed to be taken when fixing ventrally to avoid injuring the urethra. Once completed, the dartos fascia was restored, the dartos fascia and subcutaneous tissue were sutured with 4-0 absorbable suture, and skin closure is achieved subsequently. The post-operative course was without complications. At the follow-up after 1 year, the mean flaccid girth increased to 8.07 ± 1.06 cm (P < .05), while the mean erect girth increased to 12.79 ± 1.23 cm (P < .05). Sexual activity was allowed after 8 weeks of surgery. The majority reported that sexual self-esteem and functioning significantly improved. In addition, 59 patients reported alleviation of premature ejaculation. Compared to autologous dermis-fat graft and xenograft, augmentation phalloplasty using human acellular dermal matrix has several advantages: (1) it avoids harm harvesting site of the autograft; (2) the effects of dermis allograft can last at least 1 year; and (3) acellular dermal matrix is more likely to be accepted by people.