Dermal Autograft Research Articles

Dermal Autografts in Plastic Surgery: Advances, Techniques, and Clinical Outcomes

The utilization of dermal autografts in plastic surgery has evolved significantly over the past few decades, offering a versatile and reliable method for the reconstruction of various tissue defects. This article reviews the current advancements in dermal autografting, with a focus on the latest surgical techniques, integration with regenerative medicine, and the clinical outcomes observed in diverse patient populations. We discuss the biological basis of autograft survival and integration, highlight innovative approaches to enhance graft viability, and analyze complications associated with these procedures. The article also explores the role of autologous dermal grafts in aesthetic and reconstructive surgery, providing insights into future directions for research and clinical practice.

A Hybrid Corrective Technique for Nipple Eversion

Abstract An inverted nipple is defined as a nipple lying below the areola. The cause may be physiological or pathological (acute mastitis, malignancy and post-lumpectomy). There are several methods described for treating nipple eversion; however, there is no consensus as to which is the best method. Moreover, a robust technique for recurrent nipple inversion after primary eversion surgery has not been described in the literature. We describe a hybrid method of nipple eversion surgery (duct preservation + dermal autograft) that can be performed for treating both primary and recurrent nipple inversions. We have performed this technique in four patients, one primary and three recurrent nipple inversion patients, after a previous nipple eversion surgery. No recurrences have been noted to date.

Assessment of microhaemodynamics and oxygenation in tissues after the vestibuloplasty with the use of a free dermal autograft in patients after the reconstructive jaw surgery with the use of the revascularized autografts

Assessment of microhaemodynamics and oxygenation in tissues after the vestibuloplasty with the use of a free dermal autograft in patients after the reconstructive jaw surgery with the use of the revascularized autografts

Prevention of Abdominal Bulging Using Onlay Dermal Autografts from Discarded Zone IV TRAM Flap Tissue.

While the transverse rectus abdominis myocutaneous (TRAM) flap is a popular option for abdominal-based breast reconstruction, abdominal wall morbidities such as bulging or hernia remain a concern. Here, we introduced a surgical technique for reinforcing the abdominal wall using an onlay autograft obtained from discarded zone IV tissue following a primary closure. We compared abdominal wall morbidities between patients receiving an onlay graft and those receiving primary closure only. We retrospectively reviewed the medical charts of patients who underwent breast reconstruction using a TRAM flap between December 2018 and May 2021. Additionally, we assessed donor-site morbidities based on physical examination. Of the 79 patients included, 38 had received a dermal graft and 41 had not. Donor-site morbidities occurred in 10 (24.5%) and 1 (2.6%) patients, and bulging occurred in 8 (19.5%) and 1 (2.6%) patients in the primary closure and dermal autograft groups, respectively. A statistically significant difference in the incidence of bulging was observed between the groups (p = 0.030). In conclusion, the introduction of a dermal autograft after primary closure can successfully ameliorate morbidities at the TRAM flap site.

Traumatic Abdominal Wall Hernia Repair with Dermal Autograft within a Morel-Lavallée Lesion

Summary:Morel-Lavallée lesions and traumatic abdominal wall hernias seldom present together and have no standardized guidelines for treatment. We present a unique case of a traumatic abdominal wall hernia present within a patient’s abdominal Morel-Lavallée lesion, which was reduced and repaired with a dermal autograft. This is a novel approach to repairing a rare and unusual injury. The literature suggests that tension-free repairs with mesh should be used on delayed repairs of traumatic abdominal wall hernias. However, some advocate for primary repairs due to an up to 50% increased risk of wound infection in these injuries, even without the use of mesh. Although infection rates with the use of biologic mesh (acellular dermal matrices) in a contaminated field are lower than that of synthetic mesh, infections still occur and tend to be higher in repairs without mesh. The lack of foreign material and innate immunogenicity of the patient’s own dermis may theoretically decrease the risk of infection compared with other commercially-available and biologically-derived products. The patient is a 47-year-old woman who was in a motor vehicle accident with prolonged extrication time. She was hospitalized for approximately 6 months due to extensive injuries, but had no further complications from her Morel-Lavallée lesion or repair of her traumatic abdominal wall hernia with her own dermis.

PD22-02 SURGICAL OUTCOMES OF URETHRAL REVISION SURGERY AFTER GENDER AFFIRMING, SINGLE STAGE RADIAL FOREARM PHALLOPLASTY

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) II (PD22)1 Sep 2021PD22-02 SURGICAL OUTCOMES OF URETHRAL REVISION SURGERY AFTER GENDER AFFIRMING, SINGLE STAGE RADIAL FOREARM PHALLOPLASTY Mang Chen, Amanda Chi, Brad Figler, Rachel Moses, Bauback Safa, and Andrew Watt Mang ChenMang Chen More articles by this author , Amanda ChiAmanda Chi More articles by this author , Brad FiglerBrad Figler More articles by this author , Rachel MosesRachel Moses More articles by this author , Bauback SafaBauback Safa More articles by this author , and Andrew WattAndrew Watt More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002011.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urethral strictures and fistulas are common after gender affirming phalloplasty with urethral lengthening. We report our experience in urethroplasty and fistula repairs after single stage radial forearm (RF) free flap phalloplasty. METHODS: We retrospectively reviewed a high volume, single center database of 128 transmen who underwent index, single stage RF phalloplasty between October 2017 and January 2021. Urethral fistulas and strictures were characterized by repair technique, length, and location, which is further categorized as the pars pendulans (PP) urethra, pars pendulans-pars fixa (PP-PF) urethral anastomosis, and pars fixa (PF) urethra. RESULTS: In total, 25% (32/128) of patients with a median follow up of 21.5 months needed urethral revision surgery for solitary fistula (3/128), stricture (21/128), and combination stricture and fistula (8/128). Solitary fistulas developed at the PP-PF (1), PF (1), and PF-native urethra anastomosis (1). These were repaired in one stage using fistula tract excision, primary urethral closure, and dermal autograft interposition without evidence of recurrence. Remaining fistulas were successfully repaired at time of urethroplasty. Strictures developed in 29 patients and were identified in the distal PP (4), PP-PF (18), and PF (12) urethra, with a mean length of 1.4cm (range 0.5 mm-3 cm); 6 patients had more than 1 stricture. Urethroplasty techniques utilized include staged Johanson (4), Heineke-Mikulicz (HM) (18), excision and primary anastomosis (3), and substitution (10) urethroplasty—with 8 patients needing buccal mucosal graft (BMG), and 2 needing split thickness skin grafts. Of the 29 patients undergoing stricture repair, 8 (28%) developed recurrent strictures requiring additional substitution (3) and HM (4) urethroplasty, and dilation (1). Two of the 8 (25%) required a third urethral intervention. No patients required a perineal urethrostomy, and no fistula recurrences were seen in those that needed simultaneous fistula repair. CONCLUSIONS: In a single center series of gender affirming RF phalloplasty, 25% of patients developed urethral strictures and/or fistulas requiring urethral revision, most frequently at the PP-PF anastomosis. Urethroplasty and fistula repair was successful in 75% of patients. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e380-e380 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mang Chen More articles by this author Amanda Chi More articles by this author Brad Figler More articles by this author Rachel Moses More articles by this author Bauback Safa More articles by this author Andrew Watt More articles by this author Expand All Advertisement Loading ...

A simple way to manage a chronic ulcer at the cranioplasty titanium implant exposure site by dermal autograft and platelet-rich plasma

Abstract Rationale: Titanium implant exposure is not a rare complication after cranioplasty. Usually, we apply a free flap or local flap for reconstruction. Patient concerns: A 56-year-old male with a medical history of gout, hepatitis and chronic renal disease presented with an ulcer and implant exposure after titanium cranioplasty. The flap around the ulcer was too thin to perform local flap reconstruction. Free flap surgery was rejected by the patient. Diagnoses: The ulcer with implant exposure had little exudate without malodor. The underlying wound had epithelial ingrowth and was 1.5 cm × 0.5 cm in size over the left parietal region of the head. The wound culture was staphylococcus lugdunensis-positive. Interventions: Oral antibiotics and biofilm decontamination were used to manage peri-implantitis for 6 weeks. Dermal autografts were harvested with a thickness of 0.020 inches. A 2 mm wide area of de-epithelization was created around the ulcer margin. Platelet-rich plasma was locally injected into the periwound skin. Outcomes: The patient was followed up by telephone at 9 months postoperatively, and the scar condition was stable without recurrent ulcers. Lessons: Dermal autografts with platelet-rich plasma may serve as an alternative method when a local flap is not feasible and the wound defect is smaller than 1 cm2.

Alternatives to Acellular Dermal Matrix in Breast Reconstruction: Outcomes from Dermal Autograft Assisted Tissue Expander Breast Reconstruction in 104 Consecutive Patients

Alternatives to Acellular Dermal Matrix in Breast Reconstruction: Outcomes from Dermal Autograft Assisted Tissue Expander Breast Reconstruction in 104 Consecutive Patients

Dermal Autografts in Breast Reconstruction: A Review of Past and Current Trends.

Breast cancer affects 1 in 8 women. As the treatment of breast cancer evolves, breast reconstruction does as well. Implant-based reconstructions are increasing, leading to increased use of acellular dermal matrix (ADM) for better implant positioning. Acellular dermal matrices are derived from cadaveric skin and are processed to be immunologically inert. However, ADM can be costly and can have complications such as seroma and infection. This has led to the development of dermal autografts. These were first used in postmastectomy breast reconstruction in women with redundant breast skin that was deepithelialized and used for lower pole coverage of tissue expanders and implants. This evolved into harvesting dermal autografts from the abdomen. Later studies evaluated the use of meshed dermal autografts. Histological analysis of ADM versus dermal autografts shows that there are increased vessels within dermal autografts compared with ADM. This potentially contributes to the decreased complication rate seen with autografts. In addition, one study showed equivalent results in aesthetic outcomes and capsular contracture between ADM and dermal autograft. Analysis of cost has shown that ADM is significantly more costly than harvesting a dermal autograft. Physician reimbursement is also higher for dermal autografts. This review article seeks to summarize key studies that highlight the feasibility of using dermal autografts in breast reconstruction.

Utilisation du derme dorsal autologue en reconstruction lamellaire palpébrale postérieure en blépharopoïèse

Blepharopoiesis represents a double aesthetic and functional challenge. If anterior lamellar reconstruction is less discussed, the variety of posterior lamellar substitutes testifies that none is ideal. We report here our experience of the use of autologous dermal dermis as posterior lamellar substitutes in bilamellar blepharopoiesis. We performed a single-center retrospective observational study of seven patients undergoing blepharopoiesis using dorsal dermal autograft as posterior lamellar substitute. Between September 2011 and January 2017, seven patients aged of 80.9 years on average were cared for. The defect, affecting in 6 cases on 7 the lower eyelid, concerned almost three-quarter of the length of the eyelid. These defects followed the excision of basal cell carcinomas. Procedures performed under local anesthesia have simple follow-up without complications of the donor site. The superficial surface of the graft in contact with eyeball was covered in 2.4 months with a non-keratinized squamous epithelium like the conjunctiva. Two patients presented ocular functional signs during 2 months without keratitis. Two patients required a second correction procedure. The use of the dorsal dermis seems reliable, simple, fast, possible under local anesthesia and sedation, achievable in one operative time, outpatient, without temporary tarsorraphy. The graft is available in large quantities and its removal is not morbid. The good functional and esthetic results suggest that the autologous dermal dermis could represent the main alternative to palatal fibromucosa as a posterior lamellar substitute in old population.

Vascularized dermal autograft for the treatment of irreparable rotator cuff tears

Irreparable rotator cuff tears (IRCTs) are a challenging problem with diverse treatment modalities. We propose a technique for the treatment of IRCTs in which a vascularized dermal autograft is transferred to the posterosuperior region of the rotator cuff using the supraclavicular artery (SCA) island flap. Dissection of 11 fresh cadavers (19 shoulders) was performed, and the SCA island flap was harvested in all specimens. A full-thickness posterosuperior rotator cuff defect was created, and the flap was tunneled under the acromion and secured into position over the defect using multiple suture anchors. Simulated flap perfusion was then assessed, and flap measurements were recorded. There were 4 male and 7 female cadavers (19 shoulders). Flap perfusion was assessed in 10 shoulders. On average, the flap thickness was 4.7 mm (range, 3.5-7.1 mm); width, 32.6 mm (range, 25.5-38.0 mm); and length, 169.2 mm (range, 132.0-235.0 mm). The average distance from the flap tip to the Neviaser portal was 76.2 mm (range, 48.0-99.6 mm), and that from the flap tip to the anterolateral acromial edge was 54.1 mm (range, 29.5-75.1 mm). The pedicle-to-footprint distance was 113.7 mm (range, 88.5-147.0 mm). The average flap length exceeded the pedicle-to-footprint distance by 55.5 mm (range, 43.5-88.0 mm), indicating adequate excursion of the flap. All flaps demonstrated adequate simulated perfusion after fixation. The SCA island flap may be an option for a vascularized dermal autograft for IRCTs, as shown in this cadaveric study. This illustrates a possible technique with vascular viability.

Dermal Autograft Using Donor Breast as Alternative to Acellular Dermal Matrices in Tissue Expander Breast Reconstruction

Shifting preference for implant-based breast reconstruction has resulted in an increased use of acellular dermal matrix (ADM) in tissue-expander breast reconstruction. The benefits afforded by ADM must be weighed against a potential increased risk for postoperative complications. Dermal autograft-assisted breast reconstruction using autograft harvest from the lower abdomen has been shown to result in equivalent aesthetics and patient satisfaction compared with ADM at a lower cost, with fewer complications. The purpose of this study was to review a series of patients who underwent bilateral mastectomy and immediate dermal autograft-assisted tissue expander (TE) breast reconstruction using the non-cancerous breast as a donor site, comparing the outcomes with a concurrent cohort of patients undergoing ADM-assisted reconstruction to determine the relative safety, cost, and effectiveness of the 2 procedures. The study population included all patients who underwent dermal autograft-assisted TE breast reconstruction, using the contralateral cancer-free breast as the source of dermal autograft, between 2010 and 2015. The ADM cohort consisted of patients who underwent bilateral mastectomy and immediate ADM-assisted TE breast reconstruction during the same period. Univariate analysis was performed for demographic data, complications, operative cost, and operative time. Data were compared using the Wilcoxon rank sum test for nonparametric data and χ analyses for continuous and categorical variables. Significance was defined as P value less than 0.05. Seventeen patients received dermal autograft using the non-cancerous breast donor site. Twenty-seven patients who underwent ADM-assisted reconstruction during the same period were identified. Significantly higher cost was demonstrated between groups (ADM, US $9999.87; autograft, US $3924.19; P < 0.0001). No significance difference existed operative time (autograft, 97 min; ADM, 120 min). No difference was found in wound healing complications (ADM, 14.8%; autograft, 23.53%; P = 0.47). No significant difference was found in major complications (ADM, 26%; autograft, 17.65%; P = 0.52) or infectious complications (ADM, 26%; autograft, 17.65%; P = 0.52). Dermal autograft-assisted breast reconstruction using the contralateral non-cancerous breast as the source of dermal autograft harvest represents a lower cost alternative to ADM without increased risk of postoperative complications.

Surgical treatment of nasal non-melanoma skin cancer in elderly patients using dermal substitute

Conclusions: The nose is often involved by non-melanoma skin cancer (NMSC) and the increase in the incidence of such tumors, the morbidity and treatment-related costs represent a significant burden to healthcare systems. A bioresorbable dermal substitute (Hyalomatrix®) has been used for immediate dermal coverage and nose restoration after excision of infiltrating nasal NMSCs in elderly ASA III patients. Further studies on dermal substitutes are needed to improve benefit to patients.Objective: Surgical treatment of nasal non-melanoma skin cancer (NMSC) in elderly patients.Materials and methods: Ten elderly ASA III patients with nasal defects after resection of infiltrating NMSC were reconstructed in a two-stage strategy. The surgical protocol targeted an initial wide tumor excision and apposition of a dermal induction template (Hyalomatrix®) and successive full thickness skin autograft. Results were documented by photography, visual analog scale for patient satisfaction, and Vancouver scar scale for evaluation of final graft characteristics.Results: All patients were tumor-free during the 2 years follow-up. The procedure achieved acceptable nose reshaping and graft scarring evolution. Patient satisfaction was good-to-high.

Serious Burn by Sulfuric Acid: Case Report of Particular Therapeutic Strategy in a Non-Specialized ICU at H&#244;pital Principal de Dakar (HPD) S&#233;n&#233;gal

Managing severe burns remains problematic due to the lack of specialized units, but also because of the delay in implementing emergency care. The aim is to show that an adapted strategy, can lead to satisfying management of chemical burns. The authors report retrospectively the case of a patient admitted for chemical burns, and treated in a non-specialized intensive care unit; a 38 years old male, referred for burns by sulfuric acid at his workplace. On admission to H15, the clinic did not reveal any vital organs failure. Burns were localized on two legs and soles of the two feet (18% TBSA). Treatment combined daily dressings with silver sulfadiazine. On day 14, the wound healing associated occlusive gauze dressing, iodine cream application, and mechanical debridement. On day 47, a 5% dermal autograft performed on right foot favored with good attachment grafts. On day 58, the patient was released after complete skin recovery. Then, in a non-specialized burn unit and without early surgery access, our wound healing adapted strategy was successful. In Senegal, chemical burns represent about 2.5% of burn cases. They are often from accidents on occupation job, while generally in Africa chemical burns result from criminal attacks. Patients with severe lesions are admitted in non-specialized environments after an extended time of transfer, and don’t have efficient initial care. This may explain the high morbidity and mortality after burns in our country. The lack of surgical facilities such as skin substitutes, in non-specialized unit on low or median income countries (LMICs), explains this long period of wound healing. The treatment of severe burn in LMICs is hazardous.

Dermal Autograft as a Substitute for Acellular Dermal Matrix (ADM) in Tissue Expander Breast Reconstruction

INTRODUCTION: The use of acellular dermal matrix (ADM) in tissue expander breast reconstruction has several advantages but increased complications have been reported. Dermal autografts may offer a safer and more cost-effective alternative. The purpose of this prospective study was to compare the outcomes of tissue expander breast reconstruction using dermal autografts with ADM-assisted reconstruction. METHODS: Patients undergoing tissue expander breast reconstruction with either ADM or dermal autografts were enrolled. Autografts were harvested from the lower abdomen. At each follow-up visit, patients were surveyed on a seven point scale for scar and overall satisfaction. Biopsies taken at the time of device exchange were evaluated histologically with CD34 staining to assess tissue integration and vessel ingrowth. Expansion parameters, complications, procedural costs, and operative times were compared. RESULTS: Forty-eight patients were enrolled (76 breasts). Twenty-seven patients received ADM, and twenty-one patients received dermal autograft. Wound healing complications were significantly higher in the ADM group (14.8% versus 4.8%, p=0.03), as were major complications (18.5% versus 0%, p<0.01) (Table 1). Histologic vessel counts in the autograft group averaged 21 vessels/mm2, compared to 7 vessels/mm2 in the ADM group (p<0.01). There was no difference between the two groups in scar satisfaction or overall satisfaction.Table 1: Postoperative Complications.CONCLUSION: Patients receiving dermal autograft had a lower incidence of major complications and delayed wound healing than patients who received ADM. Despite harvest time, the overall cost of the ADM-assisted expander placement was higher. Dermal autograft-assisted breast reconstruction offers many of the benefits of ADM, but with a lower cost and improved safety profile.

Dermal autografts as a substitute for acellular dermal matrices (ADM) in tissue expander breast reconstruction: A prospective comparative study

The use of acellular dermal matrix (ADM) in tissue expander breast reconstruction has several advantages but increased complications have been reported. Dermal autografts may offer a safer and more cost-effective alternative. The purpose of this prospective study was to compare the outcomes of tissue expander breast reconstruction using dermal autografts with ADM-assisted reconstruction. Patients undergoing tissue expander breast reconstruction with either ADM or dermal autografts were enrolled. Autografts were harvested from the lower abdomen. At each follow-up visit, patients were surveyed on a seven-point scale for scar and overall satisfaction. Biopsies taken at the time of device exchange were evaluated histologically with CD34 staining to assess tissue integration and vessel ingrowth. Expansion parameters, complications, procedural costs, and operative times were compared. Forty-eight patients were enrolled (76 breasts). Twenty-seven patients received ADM, and twenty-one patients received dermal autograft. Wound healing complications were significantly higher in the ADM group (14.8% versus 4.8%, p-value = 0.03), as were major complications (18.5% versus 0%, p-value < 0.01). Histologic vessel counts in the autograft group averaged 21 vessels/mm(2), compared to 7 vessels/mm(2) in the ADM group (p-value < 0.01). There was no difference between the two groups in scar satisfaction or overall satisfaction. Patients receiving dermal autograft had a lower incidence of major complications and delayed wound healing than patients who received ADM. Despite harvest time, the overall cost of the ADM-assisted expander placement was higher. Dermal autograft-assisted breast reconstruction offers many of the benefits of ADM, but with a lower cost and improved safety profile.

The Use of Dermal Autograft as an Adjunct to Breast Reconstruction with Tissue Expanders

The Use of Dermal Autograft as an Adjunct to Breast Reconstruction with Tissue Expanders

Reepithelialization from Stem Cells of Hair Follicles of Dermal Graft of the Scalp in Acute Treatment of Third-Degree Burns

Sir:FigureWe read the recent interesting article “Reepithelialization from Stem Cells of Hair Follicles of Dermal Graft of the Scalp in Acute Treatment of Third-Degree Burns: First Clinical and Histologic Study,” by Zakine et al.1 We congratulate the authors for their study. However, some factual issues merit a response. The statement by the authors that “dermal autografts have never been used in burn treatment” is not true. In our study, “Application of Split-Thickness Dermal Grafts in Deep Partial- and Full-Thickness Burns: A New Source of Auto-Skin Grafting,”2 we successfully used dermal grafts in a series of burn patients. The fact that their study is not the only one applying the dermal grafts in burns probably escaped the authors' notice. Also, the statement “The dermal graft presented in our clinical experience is not conceivable on localizations other than the scalp.” Is this statement only an assumption, or have the authors had bad experience with dermal graft donor-site healing problems besides the scalp? We successfully harvested 11 dermal grafts from the thigh region without any donor-site healing problems. Thus, providing information in this way may mislead the readers of this article against dermal graft harvesting in regions other than the scalp. In the “Surgical Technique” section, the thickness of the grafts was 0.2 mm, each corresponding to 0.008 inch. However, in the “Histologic Results” section, it was 0.02 mm. In our opinion, this is a typing error. To prevent confusion for readers, we request that the numbers should be corrected. Atilla Coruh, M.D. Yalcin Yontar, M.D. Erciyes University Medical Faculty, Department of Plastic, Reconstructive, and Aesthetic Surgery, Kayseri, Turkey DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication.

The Use of Dermal Autograft as an Adjunct to Breast Reconstruction with Tissue Expanders

Acellular dermal matrices are commonly used in breast reconstruction but add cost to the procedure and have been associated with complications. Dermal autograft may represent a useful alternative to matrices. Sixteen patients (26 breasts) underwent breast reconstruction using tissue expanders and dermal autograft. Their ages ranged from 41 to 66 years (median, 51 years). Autografts were harvested by wide excision of preexisting abdominal scars. Demographic data, clinical history, and harvest and preparation time were recorded. The initial fill volume, number of expansions, and complications were recorded and compared with published data for acellular dermal matrix-assisted reconstruction. Patients rated their satisfaction with scar appearance on a seven-point scale. Follow-up ranged from 6 to 16 months (mean, 10 months). Three patients were smokers. Mean body mass index was 30.5 (range, 19.1 to 48.8). Three patients received chemotherapy between reconstructive stages, and none required irradiation. The mean time of autograft harvest was 38 minutes, the mean initial fill was 190 cc, and the average number of expansions was 3.5. There were no implant losses. There were three minor complications (19 percent). Initial expander fill, number of expansions, and complication rate were equivalent to historical values for matrix-assisted breast reconstruction. Fourteen of 16 patients (88 percent) were "very satisfied" with their scars. The use of dermal autograft in tissue expander breast reconstruction offers the advantages of acellular dermal matrix, without the associated expense. The technique adds minimally to the operative time and morbidity and is associated with a low complication rate. Therapeutic, IV.

Abdominal Wall Repair with Human Acellular Dermal Autograft

Repair of abdominal wall defects in the presence of contamination or infection is a significant problem. The loss of tissue warrants enforcement of the abdominal wall, preferably by autologous material. However, autologous repair often requires extensive surgery. This paper presents a review of available literature of placement of an acellular human dermis to repair an abdominal fascia defect, in contaminated as well as in non-contaminated surgical fields. It is illustrated with a case report that describes the successful reconstruction of an infected abdominal wall defect with a human acellular dermis allograft. A systematic literature review was undertaken with searches performed in the Pubmed and Cochrane databases for the period up till March 2009, using the search terms Alloderm [Substance Name], Hernia [Mesh] and the key words acellular dermis, acellular dermal matrix, human acellular dermal allograft and abdominal wall defect. To assess methodological quality, each article was subjected to a modification of the methodological index for non-randomized studies (MINORS) according to Slim et al. Two items from the original index were not included because none of the studies selected had an unbiased assessment of the study end points and in none of the studies was a prospective calculation of the study size performed. Seventeen studies were included in the review. Data were extracted regarding study design, number of patients, surgical technique, followup period, contaminated or non-contaminated area of the fascia defect, mortality and morbidity (hemorrhage, seroma, wound dehiscence, infection) of the operative procedure, the longterm results (removal of the graft, reherniation and bulging) and level of evidencey. A total of 169 short-term complications and 151 longterm complications occurred after 643 surgical procedures reconstructing both contaminated and clean abdominal wall defects by implantation of an HADA. Human acellular dermal allograft seems to be a good alternative for autologous repair of contaminated or infected abdominal wall defects.