Application Of Acellular Dermal Matrix Research Articles

Application of acellular dermal matrix in prevention of laryngeal stenosis in glottic carcinoma

Objective:To investigate the effect of acellular dermal matrix in preventing laryngeal stenosis in glottic carcinoma patients. Methods:Fifty-five patients with glottic carcinoma（T2, T3） from February 2018 to December 2022 were divided into experimental group（28 cases） and control group（27 cases） according to their wishes. Acellular dermal matrix was placed in the operation cavity in the experimental group after laryngofission, while control group 12 cases were sutured by pulling the upper and lower edges, 15 cases were repaired with sternohyoid muscle fascia flap. Results:In the experimental group, 1 case had laryngeal stenosis caused by laryngeal mucosa swelling after operation, and extubated successfully after symptomatic treatment. In the control group, 7 cases had laryngeal stenosis after operation, of which 3 cases were caused by granulation tissue hyperplasia in laryngeal cavity, and extubated after symptomatic treatment. 2 cases extubated after operation suffered from progressive dyspnea during radiotherapy, and underwent tracheotomy again, extubation successful after treatment. 2 cases caused by laryngeal mucosa swelling, after symptomatic treatment, one case was successfully extubated, and one case had long-term intubation. The laryngeal stenosis rate of the experimental group was 3.6%（1/28） , which was lower than control group 25.9%（7/27）, and the therapeutic effect of the experimental group was significantly better than control group （χ²=5.526, P=0.019）. Conclusion:Implanting acellular dermal matrix in the operation cavity of glottic carcinoma can reduce the occurrence of laryngeal stenosis and have satisfactory preventive effect on laryngeal stenosis.

Complete Preservation of Orbital Fat by Restoration of Attenuated Orbital Septa Using an Acellular Dermal Matrix in Lower Blepharoplasty.

We hypothesized that application of acellular dermal matrix (ADM) over the orbital septum overlying the herniated orbital fat to tighten and strengthen the attenuated orbital septum in lower blepharoplasty would allow successful repositioning of the herniated orbital fat within the bony orbit. The author prospectively compared the cosmetic outcomes of lower blepharoplasty using ADM with standard blepharoplasty. We evaluated recurrence of eyelid bulging and tear trough deformity, volume of the lower periorbital region, and enophthalmos and eyelid droop 1 year after surgery. Twenty-two of the 24 enrolled patients completed the study. There was no significant difference in recurrence of eyelid bulging and tear trough deformity between standard blepharoplasty and blepharoplasty with ADM graft groups. In the standard blepharoplasty group, the volume of the lower periorbital region decreased significantly after surgery. In the blepharoplasty with ADM graft group, there was no significant change in the volume of the lower periorbital region after surgery. In the standard blepharoplasty group, there was no significant change in eyelid droop on either side after surgery. In the blepharoplasty with ADM graft group, the eyelid droop decreased significantly after surgery on the right side but showed no significant change on the left side. There was no significant change in enophthalmos after surgery for either group. This study demonstrated that ADM graft provided effective support for maintaining the replaced orbital fat in lower blepharoplasty. In the long-term, blepharoplasty with ADM graft might be effective in slowing development of age-related enophthalmos. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Acellular dermal matrix in urethral reconstruction.

The management of severe urethral stricture has always posed a formidable challenge. Traditional approaches such as skin flaps, mucosal grafts, and urethroplasty may not be suitable for lengthy and intricate strictures. In the past two decades, tissue engineering solutions utilizing acellular dermal matrix have emerged as potential alternatives. Acellular dermal matrix (ADM) is a non-immunogenic biological collagen scaffold that has demonstrated its ability to induce layer-by-layer tissue regeneration. The application of ADM in urethral reconstruction through tissue engineering has become a practical endeavor. This article provides an overview of the preparation, characteristics, advantages, and disadvantages of ADM along with its utilization in urethral reconstruction via tissue engineering.

The Expanded Application of the Acellular Dermal Matrix: Traumatic Nail Bed Defect of the Digits.

Reconstruction of traumatic nail bed defects in the digits is a frequently encountered procedure, yet often presents many challenges. In such scenarios, staged procedures may be required with significant limitations in shape and increased donor site morbidity, particularly when multiple defects are present. In this study, we introduce a simple method for the reconstruction of nail bed defects using an acellular dermal matrix (ADM). The study involved 19 digits with nail defects, which underwent reconstruction using an ADM graft. The surgical procedure was performed on all patients on the day of injury, after which they were promptly discharged. The dimensions of the defect ranged from 0.5 × 0.5 cm to a maximum of 2 × 3 cm (average, 0.9 × 1.4 cm). Final examinations were performed at postoperative 5-11 months (average, 6.6 months). All ADM grafts were successfully taken. Nail growth was observed at an average of 4 months after surgery in the treated finger. The surgical results were retrospectively evaluated using the Zook criteria. Outcomes were "excellent" in 11 patients (57.9%), "very good" in five patients (26.3%), "good" in two patients (10.5%), and "fair" in one patient (5.2%). The expanded application of ADM explored in this study illustrates a straightforward method for the reconstruction of traumatic nail bed defects, providing effective results in a single stage without incurring donor site morbidity.

Acellular Dermal Matrix for Treatment of Diabetic Foot Ulcer: An Overview of Systematic Reviews.

Aims: To evaluate the reliability of the methodological quality and outcome measures of systematic reviews (SRs)/metaanalyses (MAs) of the acellular dermal matrix (ADM) for diabetic foot ulcer (DFU). Methods: We searched and retrieved SRs and MAs on the application of ADM for DFU from PubMed, Web of Science, The Cochrane Library, EMBASE, CNKI, CBM, WanFang, and VIP databases. We employed AMSTAR 2 to assess methodological quality, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to grade, and the strength of evidence of included SRs/MAs. We excluded the overlapping randomized controlled trials (RCTs) and conducted a re-MA of the primary RCTs. Results: A total of 7 SRs/MAs were included. Results from the AMSTAR 2 evaluation revealed a low overall quality; the GRADE system showed that the evidence was of moderate to very low quality. Our re-MA showed that ADM was superior to standard of care (SOC), with regards to complete wound healing rate at 12 weeks (RR = 1.74, 95% CI:1.34-2.25, P < .0001), complete wound healing rate at 16 weeks (RR = 1.50, 95% CI: 1.26-1.77, P ＜ .00001); healing time (MD = -2.06, 95% CI: -2.57 to -1.54, P < .00001) and adverse events (RR = 0.62, 95% CI: 0.49-0.80, P = .0002). However, a consensus has not yet been reached between ADM and SOC groups with regard to outcome indicators of the reduction of ulcer area and quality of life; and subgroup analyses showed no statistically significant differences between the xenograft ADM and SOC groups (RR = 1.36, 95% CI: 0.95-1.93, P = .09) at 12 weeks. Conclusion: Current evidence suggests that ADM is more effective than the standard of care in the treatment of DFU, particularly for full-thickness, noninfected, and nonischemic foot ulcers, but with low evidence quality. Therefore, the results of this overview should be interpreted dialectically and prudently, and the role of ADM in DFU needs further exploration.

Application of acellular dermal matrix in periodontal soft tissue augmentation surgery

The substitute materials of autologous tissue graft for periodontal soft tissue augmentation surgery develop rapidly. The use of substitute material can avoid the second operation area, shorten the operation time, reduce the postoperative reaction and pain, and is not limited by the quantity, suitable for a wide range of cases. In this paper, the characteristics, histological study, clinical application and therapeutic effect of acellular dermal matrix as a substitute material for autologous tissue transplantation were introduced to provide reference for clinical work.

Application of Acellular Dermal Matrix in Gynaecology-A Current Review.

The aim of our study is to draw attention to the multitude of applications of acellular dermal matrix (ADM) in the surgical treatment of urogynaecological disorders, such as reduction in the reproductive organs, and in reconstructive gynaecology. Despite the existence of numerous operational methods and materials, the effectiveness of transvaginal operation is still insufficient. Native tissue operations are often not durable enough, while operations with synthetic materials have numerous side effects, such as infections, hematomas, vaginal erosion, or dyspareunia. Hence, the search continues for a different material with a better efficacy and safety profile than those previously mentioned. It seems that ADM can meet these requirements and be a useful material for urogynaecological surgery. Key words related to the usage of ADM in gynaecological reconstructive surgery were used to search relevant databases (NCBI MedLine, Clinical Key, Clinicaltrials.gov). This manuscript is based on 43 literature sources, 28 (65.11%) of which were released after 2016. Older sources are cited for the purpose of presenting basic science, or other important issues related to the manuscript. ADM seems to be an ideal material for urogynaecological and reconstructive surgery. It has high durability, and thus high effectiveness. Moreover, it does not have the side effects typical for synthetic materials. There are no reports of material rejection, erosion or dyspareunia directly related to the presence of the mesh. Due to the difficulties in obtaining ADM and the need to perform additional tests, this material is not common in routine clinical practice. Therefore, the number of cases and the size of the research groups are insufficient to clearly define the potential of mesh from biological tissue. However, the results are so promising that it is worth considering a wider introduction to the use of this material. Our hope is that increasing clinicians’ awareness of this topic will lead to more studies comparing methods using native tissues or synthetic materials and those using ADM.

Application of acellular dermal matrix loaded collagen binding domain-vascular endothelial growth factor patch in urethral wound repair in beagles

Objective: To investigate the application value of acellular dermal matrix (ADM) loaded collagen binding domain-vascular endothelial growth factor (CBD-VEGF) patch in the repair of urethral wound in beagles. Methods: Twenty-one healthy adult beagles were selected to establish urethral wound model and randomly divided into 3 groups, which were treated with different repair methods. CBD-VEGF patch was prepared and instantaneous implantation was performed as the models were successfully built. The blank control group was treated without any repair materials;the ADM group was treated with collagen patch for repair and the ADM loaded with CBD-VEGF group was treated with collagen patch loaded with VEGF for repair. The safety and effectiveness of the three groups of materials implanted into the urethral wound model at 6 months after surgery were compared. Urodynamic examination, urethral angiography and pathological examination were used to evaluate the recovery of urethral tissue in the three groups. Result: Compared with blank control group and ADM patch group, there was no complications or other adverse conditions in the ADM-loaded CBD-VEGF patch group. Urethrography was performed to measure the diameter of the urethra in the experimental segment, the mean urethral diameter of blank control group [(3.07±0.43) mm] was significantly smaller than that of ADM patch group [(3.73±0.11) mm] and ADM loaded CBD-VEGF patch group [(3.64±0.32) mm], with statistical difference (P<0.05). Pathological examination with HE and Masson staining showed more proliferative blood vessels in the ADM loaded CBD-VEGF patch group. HE staining indicated that there were more proliferative vessels in the group of CBD-VEGF patch loaded with ADM. Masson staining showed that the positive area percentage of collagen tissue in the three groups was 34.27%±7.40%, 29.08%±3.79% and 28.02%±2.39%, respectively, with no statistical difference between the three groups(all P>0.05). There was no excessive deposition of collagen tissue in the two groups using collagen patch. The percentage of positive staining per unit area in the three groups were 1.4%±0.1%,1.8%±0.1%3.1%±0.2%, respectively, and the difference was statistically significant among three groups and between every two groups (all P<0.01), indicating the vascular density of CBD-VEGF group loaded with ADM was the highest. Conclusion: ADM loaded CBD-VEGF patch is a good biological support material for covering the wound after urethral surgery, and it provides an alternative direction for promoting the healing of the urethral wound.

Application of acellular dermal matrix to reconstruct the defects after hypopharyngeal carcinoma resection

PurposeReconstruction of the defects and recovery of the laryngopharyngeal function after resection of hypopharyngeal carcinoma are crucial for patients to promote the rate of survival and the quality of life. We launched this study to explore the advantages and limitations of acellular dermal matrix applied in the reconstruction of the defects after hypopharyngeal carcinoma surgery. Materials and methodsCollected the clinical and pathological data of patients with hypopharyngeal carcinoma, divided them into 2 groups according to the repair materials used (pectoralis major myocutaneous flap or acellular dermal matrix). The clinical data and postoperative complications were analyzed and compared. ResultsNo matter whether the pectoralis major myocutaneous flap or acellular dermal matrix was used to repair hypopharyngeal cancer resection defects, the postoperative complications, especially the pharyngeal fistula rate, were not significantly different. The postoperative drainage volume of patients with acellular dermal matrix was less than that of patients with pectoralis major myocutaneous flap. ConclusionsAcellular dermal matrix is a safe and effective biomedical material for hypopharyngeal cancer operation defects repair and pharyngeal function reconstruction, which can simplify the operation process, reduce the postoperative drainage volume, and decrease the risk of wound infection or pharyngeal fistula.

Adoption of a Newly Introduced Dermal Matrix: Preliminary Experience and Future Directions.

Introduction Acellular dermal matrix (ADM) products are adopted in the management of injuries to soft tissues. ADMs have been increasingly employed for their clinical advantages, and they are acquiring relevance in the future of plastic surgery. The aim of our study is to evaluate the application of ADMs in our patients who could not undergo fast reconstruction. Materials and Methods We performed a retrospective study on 12 patients who underwent ADM placement for scalp and limb surgical reconstructions at the Humanitas Research Hospital, Rozzano (Milano), Italy. Wounds resulted from 9 tumor resections and 3 chronic ulcers. The ADM substrate used to treat these lesions was PELNAC™ (Gunze, Japan), a double-layered matrix composed of atelocollagen porcine tendon and silicon reinforcement. All patients underwent a second surgical operation to complete the treatment with a full-thickness skin graft to cover the lesion. Results In this study, 12 patients were treated with PELNAC™: 11 out of 12 patients showed a good attachment over a median time of 21.3 days (range 14-27). After almost 23 days, all patients were ready to undergo a full-thickness skin grafting. Conclusion This study assesses the benefits of PELNAC™ and proposes this method as an alternative to traditional approaches, especially in situations where the latter techniques cannot be applied.

Treatment Strategy for an Electrical Burn Patient with Multiple Fourth-Degree Wounds

Electrical burns, especially high-voltage burns, usually cause necrosis of the subcutaneous fat, fascia, muscle, and bone. The reconstruction of electrical injuries often involves multiple surgeries. We present the case of a 56-year-old man who was injured by a high-voltage current resulting in multiple soft tissue defects on the left ankle and plantar area. The wounds on the malleolar and lateral plantar areas had burned the muscle, tendon, and bone. Because the patient had multiple wounds and unstable vessels, we took the strategy of operating in stages. The primary aim of treatment was wound healing and maintaining the support structure for mobility. Several rounds of wide debridement and negative-pressure wound therapy, followed by application of acellular dermal matrix and split-thickness skin graft were performed as part of the first stage. At the 1-year follow-up, the patient could walk independently wearing a splint to prevent foot drop. A second reconstructive surgery is possible, if necessary.

Efficacy of Acellular Dermal Matrix in Capsular Contracture of Implant-Based Breast Reconstruction: A Single-Arm Meta-analysis.

A large number of clinical studies have suggested that acellular dermal matrix (ADM) can decrease the incidence of capsular contracture in implant-based breast reconstruction. Yet, there is currently no high-level epidemiological evidence to prove this. The goal of this meta-analysis was to clarify the efficacy of ADM in capsular contracture, and provide a reference value for plastic surgeons. We systematically performed a search on PubMed, EMBASE, and the Cochrane Library to identify eligible studies from inception up to October 1, 2019. A random-effects model was used to obtain a pooled incidence rate. We conducted subgroup analysis according to geographic region, type of ADM, body mass index (BMI), duration of follow-up, and proportion of participants who have received radiotherapy. A total of 18 studies involving 2941 cases were included. Overall, the pooled incidence rate of capsular contracture was 2.4% (95% CI 1.2-3.9%). The results from subgroup analyses indicated an even lower incidence in North America (1.6%, 95% CI 0.5-3.3%) and in human-derived ADM (HADM) (1.2%, 95% CI 0.2-3.0%). In addition, the results showed that the patients with BMI < 24, or who have received radiotherapy, were more prone to capsular contracture. The application of ADM can effectively reduce the incidence of capsular contracture in implant-based breast reconstruction. And we infer that it might also apply to breast augmentation. However, additional high-quality trials are warranted to corroborate the findings of this meta-analysis. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

An Algorithmic Approach to Prepectoral Direct-to-Implant Breast Reconstruction: Version 2.0.

Prepectoral direct-to-implant breast reconstruction has historically been fraught with complications, including flap necrosis, implant extrusion, and capsular contracture, along with high rates of operative revisions. This may result from a number of factors, including the lack of an algorithmic approach, failure to predict postoperative migration of the implant, use of improper implants, and unsuitable patient selection. Over the past 5 years, the authors have gained significant experience in prepectoral breast reconstruction as they have transitioned their direct-to-implant technique. Using video, technical aspects for achieving superior results are demonstrated, including suture technique, application of acellular dermal matrix, creation of the implant pocket, implant selection and placement, and postoperative dressings. Video is used to highlight technical aspects to yield consistent, predictable results using the anterior tenting technique. A systematic review of prepectoral direct-to-implant breast reconstruction was conducted to amalgamate the experience of the authors and others with regard to technique, material, and outcomes. Prepectoral direct-to-implant breast reconstruction represents a significant paradigm shift in postmastectomy breast reconstruction and warrants reconsideration. Prepectoral direct-to-implant breast reconstruction provides the potential benefits of a single-stage operation, elimination of dynamic deformity, enhanced aesthetic outcomes, and increased patient satisfaction. Although early evidence suggests an increased incidence of complications, our experience and that of others demonstrate favorable outcomes with version 2.0 of prepectoral direct-to-implant breast reconstruction. As the body of literature encompassing a modern approach to prepectoral direct-to-implant breast reconstruction grows, greater appreciation for operative technique, candidate selection, and implant choice may accelerate its adoption and mitigate past concerns.

Preparation of ADM/PRP freeze-dried dressing and effect of mice full-thickness skin defect model

Acellular dermal matrix (ADM) and platelet-rich plasma (PRP) have each been used in wound healing. There are a few reports on the application of ADM with PRP in skin full-thickness defect models. In this study, the microstructure of ADM/PRP freeze-dried dressing was observed by scanning electron microscope. The PRP, ADM and PRP/ADM samples were recorded by Fourier transform infrared (FTIR) spectrometer by the KBr methods. The concentration of growth factor was measured by enzyme-linked immunosorbent assay. Then, we made a mice full-thickness defect model and treated it with saline, PRP, ADM and PRP/ADM, respectively. The wound size was measured and calculated on days 3, 5, 7, 10 and 14. The obtained results demonstrated that the ADM/PRP freeze-dried dressing resulted in earlier collagen development. FTIR analysis confirmed the integration of ADM and PRP in the prepared PRP/ADM scaffold. The concentration of bFGF, EGF, TGF-β1 and PDGF-BB in the ADM/PRP group was lower than that in the PRP group. The wound healing rate of the ADM/PRP group was significantly promoted. Furthermore, the ADM/PRP group had significant revascularization, rapid epithelialization and a well-differentiated epidermis. The collagen fibers were regularly arranged. Accordingly, ADM/PRP freeze-dried dressing promotes wound healing and can be used in the skin full-thickness wound.

Clinical analysis of acellular dermal matrix and acellular bone matrix in oro-antral fistula repair

This study aimed to investigate the application of acellular dermal matrix and acellular bone matrix in the management of oro-antral fistula. Nine patients with oro-antral fistula (with defect greater than 5 mm×5 mm) after maxillary cyst resection or maxillary molar extraction were selected. The defects were repaired by the simultaneous implantation of acellular dermal matrix and acellular bone matrix. The incisions of nine patients were all primary healing. After 6 months of follow-up, the oro-antral communication healed well, and no symptom such as nasal congestion or runny nose was observed. The clinical and CT examinations confirmed wound healing. The usage of acellular dermal matrix and acellular bone matrix is a reliable repairing method for ora-antral fistula.

Application of acellular dermal matrix without skin graft in fingertip injury

Application of acellular dermal matrix without skin graft in fingertip injury

Clinical application of acellular dermal matrix on repairingexternal auditory canal skin defects

Clinical application of acellular dermal matrix on repairingexternal auditory canal skin defects

Aseptic versus Sterile Acellular Dermal Matrices in Breast Reconstruction: An Updated Review.

Background:As the use of acellular dermal matrices in breast reconstruction has become more commonplace and efforts are made to improve on postoperative outcomes, the method of acellular dermal matrix (ADM) processing (aseptic versus sterile) has become a subject of interest. This article provides an updated overview of the critical aspects of ADM processing in addition to application of ADMs in single- and two-stage breast reconstruction, a review of the morbidity associated with ADM use, and alternatives.Methods:A literature review was performed in PubMed identifying recent systematic reviews, meta-analyses, and head-to-head comparisons on aseptically processed ADM and sterile-processed ADM in implant-based breast reconstruction.Results:Recent meta-analyses have shown a 2- to 3-fold increase in infections and tissue expander/implant explantation rates and a 3- to 4-fold increase in seroma formation compared with non-ADM reconstruction techniques. Comparisons of aseptic and sterile ADMs in multiple studies have shown no significant difference in infection rates and equivocal findings for other specific complications such as seroma formation.Conclusions:Current evidence on the impact of processing techniques that improve ADM sterility on postoperative morbidity in implant breast reconstruction is unclear. Deficiencies of the available data highlight the need for well-designed, multicenter, randomized controlled studies that will aid in optimizing outcomes in implant-based breast reconstruction.

Prospective Randomized Comparison of Scar Appearances between Cograft of Acellular Dermal Matrix with Autologous Split-Thickness Skin and Autologous Split-Thickness Skin Graft Alone for Full-Thickness Skin Defects of the Extremities.

Sir: We read with interest the recent article by Yi and Kim (Plast Reconstr Surg. 2015;135:609e–616e). The authors compared the effect of simultaneous application of acellular dermal matrix with autologous split-thickness skin graft and that of split-thickness skin graft alone on traumatic full-thickness skin defects on the extremities, and concluded that the cograft of acellular dermal matrix with split-thickness skin graft produced better outcomes than split-thickness skin graft alone in terms of scar appearance, without increasing complications. The combination of acellular dermal matrix with epidermal coverage, usually an autologous split- thickness skin graft, has increasingly replaced the full-thickness skin graft to reconstruct full-thickness skin defects. However, the timing of split-thickness skin grafting remains controversial. For a split-thickness skin graft to attach promptly after transplantation, a well-vascularized wound bed is required. The thickness of a skin graft that can easily become vascularized is approximately 0.7 to 1.0 mm. Therefore, most acellular dermal matrices thicker than 1.0 mm are covered by a split-thickness skin graft 3 to 4 weeks later to allow sufficient vascularization and to avoid graft necrosis or loss.1 However, this two-step approach is lengthy, gives no guarantee of success, and is an additional stress factor for the patient. More recent approaches include use of thinner dermal layers, with the aim of transplanting acellular dermal matrix simultaneously with split-thickness skin graft.2 Several of the authors’ procedures might contribute to the success of their single-step technique: (1) the wound bed was completely débrided and prepared with well-vascularized granulation tissue before grafting, (2) negative-pressure therapy was applied throughout to stimulate angiogenesis and prevent complications, and (3) the application of meshed acellular dermal matrix and thin split-thickness skin graft improved the take rate and allowed better blood supply to the cograft. However, we still have great interest in the thickness of the acellular dermal matrix in this article. Does the meshed morphology of acellular dermal matrix compensate for the thickness of it? In addition, the split-thickness skin graft combined with acellular dermal matrix was meshed and expanded, whereas the split-thickness skin graft applied alone was neither meshed nor expanded and was 0.1 mm thicker than the cografted one. The difference interests and confuses us. Beyond this, the pigmentation merits specific attention. Melanocytes and fibroblasts are believed to contribute to the repigmentation process.3 Because acellular dermal matrix does not contain cellular components, it is acceptable in this article that the pigmentation subscore was not improved in the cograft group. In our experience, noncultured autologous cell suspensions, such as ReCell (Avita Medical, Northridge, Calif.), could commendably improve skin color, as it contains viable melanocytes and fibroblasts apart from abundant keratinocytes.4 As these authors move forward, it could be tentatively used to aid the cograft of acellular dermal matrix and split-thickness skin graft or even cografted directly with acellular dermal matrix to heal full- thickness skin defects. We agree with the authors that the one-step graft of acellular dermal matrix and split-thickness skin graft is more than welcome and encourage them and others to investigate this approach so that this very important technique can be more completely understood and taken advantage of. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Panxi Yu, M.D.Zuoliang Qi, M.D., Ph.D.Plastic Surgery HospitalChinese Academy of Medical Sciences and Peking UnionMedical CollegeBeijing, People’s Republic of China

Reply: Prospective Randomized Comparison of Scar Appearances between Cograft of Acellular Dermal Matrix with Autologous Split-Thickness Skin and Autologous Split-Thickness Skin Graft Alone for Full-Thickness Skin Defects of the Extremities.

Sir: We would like to thank Yu and Qi for their interest in and comments on our article. We note they welcomed the described protocol of single-stage application of acellular dermal matrix and split-thickness skin graft for the coverage of full-thickness skin defects. However, they raised questions regarding what might contribute to the success of our single-stage technique. We believe that the most important factor of successful graft take is the thickness of cograft, as they mentioned. The thickness of acellular dermal matrix used in our study1 was within the range of 0.23 to 0.33 mm, and the thickness of split-thickness skin grafts in the cograft group was 0.25 mm, which means that the total thickness of cograft (acellular dermal matrix plus split-thickness skin graft) was within the threshold (0.7 mm) for successful skin grafting.2 Negative-pressure wound therapy could have promoted microcirculatory flow to the graft and wound edges; stimulated angiogenesis and basement membrane integrity; prevented complications of graft lift-off by edema, exudates, and subgraft hematoma; and reduced shear stress compared with traditional dressings.3 We used negative-pressure wound therapy to promote well-vascularized granulation tissue before skin grafting and to provide a better environment for skin graft take; thus, it is possible that negative-pressure wound therapy had a beneficial effect on successful graft take. However, negative-pressure wound therapy was used in both groups and thus could not have caused an intergroup difference. The mesh-like morphology of the acellular dermal matrix would also have promoted successful graft take by preventing fluid accumulation and hematoma formation. However, this aspect was beyond the scope of our study, and we suggest further clinical or basic study be undertaken to prove this hypothesis. Yu and Qi commented that addition of ReCell (Avita Medical, Northridge, Calif.) could improve pigmentation in the cograft group. However, we are skeptical of this notion, because split-thickness skin graft contains melanocytes and fibroblasts, and hyperpigmentation rather than hypopigmentation is more common in our patients, although we admit racial difference regarding this issue. They also suggested the insightful idea of using an acellular dermal matrix and ReCell cograft for full-thickness skin defects. We welcome this idea because such an approach could potentially treat full-thickness skin defects, with minimal donor-site morbidity. DISCLOSURE The original study was supported by a research grant from Daewoong Bio Incorporation and all of acellular dermal matrix and CURAVAC were donated by Daewoong Bio Incorporation. Otherwise, none of authors has financial interest to declare in relation to the content of this communication. Jae Kwang Kim, M.D., Ph.D.Department of Orthopedic SurgeryEwha Womans UniversitySchool of MedicineSeoul, Republic of Korea Ju Won Yi, M.D.Department of Orthopedic SurgeryArmed Forces Capital HospitalSeongnam, Republic of Korea