Efficacy Of Acellular Dermal Matrix Research Articles

Efficacy of Acellular Dermal Matrix Versus Connective Tissue Graft for Root Coverage in Patients with Gingival Recession: A Meta-Analysis.

This study aimed to compare the efficacy of acellular dermal matrix (ADM) versus connective tissue graft (CTG) for root coverage in patients with gingival recession. Randomized controlled trials (RCTs) on the comparison of ADM with CTG in adult patients with gingival recession were searched in multiple databases updated on 15th May 2020. The quality of studies was evaluated using the upgraded Jadad scale. Included studies were assessed for percent root coverage (PRC), clinical attachment level (CAL), keratinized tissue (KT), probing depth (PD), recession width (RW) and recession depth (RD). Weighted mean difference (WMD) was used as the statistics for measurement data and the effect sizes were expressed as 95% confidence intervals (CI). Totally 24 RCTs were eligible for the final analysis. The patients accepting ADM had a higher gain in CAL (WMD: 0.250, 95%CI: 0.030-0.470, P=0.026) but a smaller gain in KT width (WMD: -0.440, 95%CI: -0.629--0.252, P<0.001) than those receiving CTG. No significant differences were found between the patients accepting ADM and those undergoing CTG in PRC (WMD: -1.608, 95%CI: -3.491-0.275, P=0.094), PD (WMD: 0.066, 95%CI: -0.005-0.137, P=0.067), RW (WMD: 0.065, 95%CI: -0.098-0.228, P=0.437) and RD (WMD: 0.109, 95%CI: -0.095-0.314, P=0.294). Overall, the ADM treatment for patients with gingival recession may be superior to CTG in gaining CAL, but CTG has a significant advantage over ADM in gaining KT width.

Efficacy of Acellular Dermal Matrix in Soft Tissue Augmentation Around Dental Implants: A Systematic Review and Meta-Analysis.

This study was done to perform a systematic review and meta-analysis of the studies on the efficacy of acellular dermal matrix (ADM) in increasing the soft tissue thickness (STT) and keratinized mucosal width (KMW) around dental implants. The PubMed, Scopus, Cochrane, Web of Science, and ProQuest databases were searched by July 2020 to retrieve relevant studies. Depending upon the heterogeneity of included studies, the weighted mean difference (WMD) with 95% CI was calculated using either fixed or random-effects model. Based on the meta-analysis of 6 studies, the effect of ADM on STT and KMW was significant (WMD: 1.07 [95% CI: 0.34-1.79], P = .004, and WMD: 1.99 [95% CI: 0.88-3.09], P < .001, respectively). Further, a comparison between the efficacy of the ADM and the control group, which included the autogenous soft tissue augmentation techniques, showed no statistically significant differences between groups (STT: WMD: 0.24 [95% CI: -0.26 to 0.74], P = .161 and KMW: WMD: -0.23 [95% CI: -0.68 to 0.22], P = .324). The subgroup analysis showed that simultaneous augmentation and implant placement were increased by 0.23 mm in the KMW, and the placement of ADM around loaded implants caused 0.5 mm decrease in the KMW, which was not statistically significant. Accordingly, it is possible to substitute ADM for soft tissue augmentation around dental implants.

Implantation of Acellular Dermal Matrix to Prevent Frontotemporal Depression Following Minipterional Craniotomy for the Surgical Clipping of Unruptured Intracranial Aneurysms

The objective of the study was to assess the esthetic efficacy of acellular dermal matrix (ADM) implantation to prevent frontotemporal depression (FTD) following minipterional craniotomy (MPT) to clip unruptured intracranial aneurysms. We retrospectively compared the incidence of FTD in 100 patients treated without ADM from March to July 2019 and 100 patients treated with ADM from August to December 2019. ADM was implanted in the interfascial layer to cover the temporalis muscle. The specific location and degree of FTD were analyzed by measuring the thickness and area of multiple points (P1-P12) and regions (S1-S3) through brain computed tomography preoperatively and 1year postoperatively. In the non-ADM group, the thickness at P1, P2, P5, P6, and P9 was reduced and the area of S1 and S2 was smaller after surgery than before surgery (P<0.05), similar to the incision and suture site of the temporalis muscle. However, in the ADM group, the preoperative and postoperative measurements were not different. FTD recognition was significantly lower in the ADM group (6.0%) than that in the non-ADM group (17.0%) (P=0.015) and occurred in the retroorbital region through P1, P2, P5, and P6, with the area under the receiver operating characteristic curves of 0.840, 0.766, 0.811, and 0.751, respectively. ADM implantation was the only significant predictive factor for FTD recognition in multivariate logistic regression analysis (odds ratio=0.30; 95% confidence interval: 0.11-0.79; P=0.015). Even MPT cannot completely prevent FTD in the retroorbital region. ADM implantation in MPT can help to improve esthetic satisfaction.

Acellular dermal matrix for prevention of Frey's syndrome after superficial parotidectomy of benign tumors

PurposeTo evaluate: 1) the efficacy of acellular dermal matrix (ADM) to prevent Frey's syndrome (FS) after superficial parotidectomy of benign tumors. 2) the effect of different follow-up intervals on the incidence of FS. MethodsFifty-five patients with benign parotid gland tumors underwent superficial parotidectomy were divided into two groups: Non-ADM group (n = 31, 56.3%) and ADM group (n = 24, 43.6%). The primary outcomes measure was the incidence of FS. The secondary outcomes were surgical site depression, infection, salivary sialocele, and salivary fistula. Subjective FS was evaluated using a clinical questionnaire submitted via WeChat at 3, 6, 12, 18, 24, and 32 months postoperatively. Objective FS was evaluated using Minor starch–iodine test at 6 and 12 months postoperatively. ResultsThere was a statistically significant difference in the incidence of subjective and objective FS when ADM compared with Non-ADM groups (P<0.05). The respective incidence of subjective FS at 3, 6, 12, 18, 24, and 32 months was 4.2%, 8.3%,20.8%, 20.8%, 20.8%, 20.8% in ADM group and 3.2%, 9.7%, 29%, 38.7%, 45.2% in Non-ADM group. The incidence of objective FS after 6 and 12 months was 4.2%, 8.3% in ADM group and 8.3% (2/24), 38.7% (12/31) in Non-ADM group respectively. Five patients in ADM group and 1 patient in Non-ADM group developed sialocele, and all patients resolved with conservative management. Surgical site depression was significantly higher in the Non-ADM group (15/31) compared with (5/24) in ADM (P=0.049). No cases of immune rejection, infection, hematoma, or salivary fistula were observed in ADM group. ConclusionsThe current study demonstrated that 1) ADM could reduce the incidence of FS in the patients undergoing superficial parotidectomy. 2) the peak onset of about 18 months appear to be acceptable follow-up for the development of FS.

Acellular dermal matrix as an alternative to autologous fascia lata for skull base repair following extended endoscopic endonasal approaches.

Skull base reconstruction after extended endoscopic endonasal approaches (EEAs) can be challenging. In addition to the nasoseptal flap, which has been adopted by most centers, autologous fascia lata is also often utilized. Harvesting of fascia lata requires a separate thigh incision, may prolong recovery, and results in a visible scar. In principal, the use of non-autologous materials would be preferable to avoid a second incision and maintain the minimally invasive nature of the approach, assuming the CSF leak rate is not compromised. To assess the efficacy of acellular dermal matrix (ADM) as a non-autologous alternative to autologous fascia lata graft for watertight closure of the cranial base following EEAs. A retrospective chart review of extended EEAs performed before and after the transition from fascia lata to ADM was performed. Cases were frequency matched for approach, pathology, BMI, use of lumbar drainage, and tumor volume. Power analysis was performed to estimate the sample size needed to demonstrate non-inferiority. ADM was used for watertight closure of the cranial base in 19 consecutive extended endoscopic endonasal approaches (16 gasket-seals and 3 buttons) with 1 postoperative CSF leak at the last follow-up (median 5.3, range 1.0-12.6months). All patients had high-flow intraoperative leaks. The cohort included 8 meningiomas, 8 craniopharyngiomas, 2 chordomas, and 1 pituicytoma ranging in size from 0.2 to 37.2cm3 (median 5.5, IQR 2.8-13.3cm3). In 19 historical controls who received fascia lata, there were 2 postoperative CSF leaks. Preliminary results suggest that ADM provides a non-inferior non-autologous alternative to fascia lata for watertight gasket-seal and button closures following extended EEAs, potentially reducing or eliminating the need to harvest autologous tissue.

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.

Acellular dermal matrix in premature ejaculation: A preliminary study.

Background:To investigate the efficacy of acellular dermal matrix in penis augmentation (ADMPA) for premature ejaculation (PE).Methods:A total of 39 patients treated with ADM in penis augmentation from June 2014 to December 2017 were evaluated. Detailed evaluations on PE were conducted before operation and at the 6-month and 2-year follow-up visits after operation. Self-estimated intravaginal ejaculatory latency time (IELT) and 5-item version of the International Index of Erectile Function (IIEF-5) were used to measure the ejaculation and the erectile function for all subjects.Results:Compared to the baseline data, the IELT and IIEF-5 scores were increased, and PE was relieved at 6 months and 2 years after operation. No major complications occurred in the series. Minor complications were resolved with conservative treatment within 3 weeks. The psychosexual impact of the operation was beneficial in the majority of cases.Conclusion:Our survey systematically evaluated the effects of ADMPA for PE. ADMPA might be an optional surgical method in patients with PE, especially for those who seek penile augmentation. However, given the small amount of cases involved in this study, further studies on the effect of ADMPA for PE were still needed.

Efficacy of acellular dermal matrix and autogenous connective tissue grafts in the treatment of gingival recession defects among Asians

The aim of the present study was to assess the efficacy of acellular dermal matrix (ADM) and subepithelial connective tissue grafts (sCTG) in the treatment of Miller class I and II gingival recession (GR) defects. Six patients with eight GR sites were randomly assigned to the test group (GR defects treated with ADM) and control group (GR defects treated with sCTG). Recession height (RH) and width, probing depth, keratinized gingiva, clinical attachment level, and full mouth plaque and bleeding scores were measured at baseline, 3 and 6months. The differences in mean changes were insignificant between the two groups in all parameters. In both groups, improvements from baseline to 3 and 6months were significant for mean RH reduction and clinical attachment gain. A significant increase in the mean keratinized gingiva width was observed in both groups at 3 and 6months. ADM and sCTG yield similar outcomes when used in the treatment of GR defects.

Treatment of gingival recession with coronally advanced flap combined with connective tissue graft/alloderm: A systematic review

The purpose of this systematic review was to compare the efficacy of acellular dermal matrix (ADM) with coronally advanced flap (CAF) to connective tissue graft (CTG) with CAF in the treatment of localized Miller's Class I and II gingival recessions. Systematic review was limited to randomized clinical trials (RCTs) on the treatment of Miller Class I and II gingival recessions with at least 6 months of follow-up. Articles from January 1 1990 to June 2014 related to ADM were searched utilizing the MEDLINE database from the National Library of Medicine and through hand searches of reviews and recent journals. The primary outcome variable was root coverage (RC). A total of 248 Miller Class I and II gingival recessions in 143 patients from 10 RCTs were evaluated in this systematic review. Data collected by this study connote the following: There were no significant differences between ADM with CAF and CTG with CAF for recession coverage, and both procedures may be equally effective in clinical practice. Within the limitations of this study, it appears that ADM-based periodontal plastic surgery can be used successfully to treat gingival recession defects and to increase keratinized gingiva.

Efficacy of Acellular Dermal Matrix and Coronally Advanced Flaps for the Treatment of Induced Gingival Recession Defects: A Histomorphometric Study in Dogs

Gingival recession (GR) defects can be treated by various methods, including acellular dermal matrix (ADM) or coronally advanced flaps (CAFs). The aim of this histomorphometric experiment is to compare the efficacy of ADM and CAF for treating GR defects in dogs. In eight beagle dogs, a critical-size labial GR defect was surgically induced on bilateral maxillary cuspids under general anesthesia. Test sites received ADM and CAF, and control sites underwent CAF treatment alone. Plaque index (PI), bleeding index (BI), and gingival index (GI) were measured at 4 weeks (baseline), 8 weeks, and 16 weeks. Width of keratinized gingiva (KG) was determined at baseline and at 16 weeks. Depth of recession and width of GR below the cemento-enamel junction (CEJ) was also determined. After 4 months, animals were sacrificed, and jaw blocks were histomorphometrically assessed for tissue thickness and distance from the stent to the gingival margin (GM) and to the CEJ. At 4-, 8-, and 16-week intervals, there was no significant difference in the BI, GI, and PI at the test and control sites. At 16 weeks, thickness of KG was significantly higher at the control sites than test sites (P <0.01). There was no difference in the midfacial recession depth and recession width at the test and control sites at baseline and before euthanasia (16 weeks). Histomorphometrically, there was no significant difference in tissue thicknesses and distances from the stent to the GM and CEJ in the test and control sites. ADM might yield similar results to a CAF alone and could decrease the amount of KG.

Repair of abdominal wall hernias using acellular dermal matrix in goats

The present study was undertaken to evaluate the efficacy of acellular dermal matrix (ADM) of caprine origin for the repair of abdominal wall hernias in six goats. The skin of goat was de-epithelialised using a 2 M sodium chloride solution and 0.25% trypsin, and further decellularised using 2% sodium deoxycholate, which was then used as graft material. Under xylazine sedation and local infiltration analgesia, the abdominal wall hernias were repaired with ADM graft using inlay graft technique. All animals had an uneventful recovery without clinical signs of wound dehiscence, infection or recurrence of hernia during 6 months follow-up periods.

A Systematic Review of Acelluar Dermal Matrices in Head and Neck Reconstruction

The use of acellular dermal matrices has been well described in the scientific literature since the early 1990 s and has been utilized for multiple applications in the head and neck for both aesthetic and reconstructive efforts. After systematically searching the PubMed database and following further refinement (based on the authors' inclusion and exclusion criteria), the authors identified 30 studies that provided information about patients who had undergone head and neck reconstruction with the use of acellular dermal matrix. Studies had to report quantifiable objective results in patients who were older than 1 year and younger than 90 years. The authors excluded single case reports, studies with fewer than 10 patients, and studies not published in English. The optimal material used as an implant for reconstruction possesses the following properties: facilitation of vascular ingrowth, decreased propensity to incite inflammation, biologic inertness, resistance to infection, and ease of handling. Acellular dermal matrix possesses many of these properties and is utilized in reconstructing nasal soft tissue and skeletal support, tympanic membrane, periorbital soft tissue, extraoral and intraoral defects, oropharyngeal defects, dura mater, and soft-tissue deficits from parotidectomy. Furthermore, it is used to assist in preventing Frey syndrome following parotidectomy and surgical treatment of facial paralysis. Use of acellular dermal matrix for head and neck reconstruction has expanded exponentially and is validated in many studies. Further prospective randomized control trials are warranted to further investigate the efficacy of acellular dermal matrix in head and neck reconstruction.

Study of healing mechanism of acellular dermal matrix in the treatment of anal fistula

To evaluate the efficacy of acellular dermal matrix(ADM) in the closure of anal fistula in an experimental porcine model, and to explore its healing mechanism. The fistula-in-ano model was created and treated with ADM in the porcine model (n=14). Fistula specimens were obtained at hour 12, 24 and day 3, 7, 14, 28, 60 respectively with 2 pigs in each time point. Hematoxylin and eosin staining and immunohistochemical staining for the alpha smooth muscle actin (α-SMA) were performed. At 12 hours after implantation, neutrophils and scattered cells with a fibroblastic appearance were present at the interface and began to infiltrate into the ADM. The cell density increased from hour 12 (218.2±58.2) to day 7(998.7±128.0) (P<0.01), and decreased from day 7 to day 28. Mature vessels and myofibroblasts stained with α-SMA were identified at the edge of ADM at day 7. The density of vessels (11.2±3.3 vs. 30.5±5.2, P<0.01) and myofibroblasts (3.8±0.8 vs. 6.8±0.4, P<0.01) increased from day 7 to day 14. Partially organized bundles of muscle were found at day 60. ADM is a reasonable new option for the closure of anal fistula. The ability of ADM to become vascularized and remodeled by autologous cells may be advantageous for anal fistula healing and other chronic septic wound.

Efficacy of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction

Efficacy of Acellular Dermal Matrix in Postmastectomy Breast Reconstruction

Application of acellular dermal matrix for intestinal elongation in animal models

To investigate the efficacy of acellular dermal matrix (ADM) for intestinal elongation in animal models. Japanese white big-ear rabbits (n = 9) and Wuzhishan miniature pigs (n = 5) were used in the study. Home-made and commercial ADM materials were used as grafts, respectively. A 3-cm long graft was interposed in continuity with the small bowel and a side-to-side anastomosis, distal to the graft about 3-4 cm, was performed. The animals were sacrificed at 2 wk, 4 wk, 8 wk and 3 mo after surgery and the histological changes were evaluated under light microscope and electron microscope. The animals survived after the operation with no evidence of peritonitis and sepsis. Severe adhesions were found between the graft and surrounding intestine. The grafts were completely absorbed within postoperative two or three months except one. Histological observation showed inflammation in the grafts with fibrinoid necroses, infiltration of a large amount of neutrophils and leukomonocytes, and the degree varied in different stages. The neointestine with well-formed structures was not observed in the study. It is not suitable to use acellular dermal matrix alone as a scaffold for the intestinal elongation in animal models.

Acellular dermis compared to skin grafts in oral cavity reconstruction

To compare the efficacy of acellular dermal matrix (ADM) and split thickness skin grafts (STSG) in oral cavity reconstruction. Prospective cohort study. Thirty-four patients were included in this study (ADM, n = 22; STSG, n = 12). Evaluation for patient demographics, graft site, graft contracture, and functional status as defined by the EORTC QLQ-C30 and the H&N35 questionnaires. A subgroup of patients underwent graft site biopsy for histological analysis. A cost estimate of both procedures was also performed. Patient groups were similar in age, sex, race, smoking exposure, and site grafted. More patients were treated with radiation therapy (pre- or postoperative) in the ADM group (45%) compared to the STSG group (17%). Graft failure rate was higher in the ADM group (14% vs. 0%), and both groups had similar estimated graft contraction. The quality of life survey results favored the ADM group, but only the category of trouble with social eating was statistically significant (P = .03). Radiation therapy had a significantly negative impact for both ADM and STSG. Histology demonstrated increased inflammation, fibrosis, and elastic fibers in the STSG group. The cost of the STSG was 3.5 times higher than the ADM group. Acellular dermis grafting for reconstruction of the oral cavity offers several advantages over STSG, including the lack of donor site morbidity, lower cost, a natural appearing mucosal surface, and comparable if not superior functional status. Lower graft survival rates for ADM in the setting of prior radiation and with thicker graft material was encountered.

Characterization of acellular dermal matrices (ADMs) prepared by two different methods

The efficacy of acellular dermal matrix (ADM) in the treatment of full-thickness skin injuries as a dermal substitute depends on its low antigenicity, capacity for rapid vascularization, and stability as a dermal template. These properties will be determined largely by the final composition of the ADM. We have treated human skin with either Dispase followed by Triton X-100 detergent or NaCl followed by SDS detergent, cryosectioned the resulting ADMs, and then characterized them immunohistochemically. Staining for cell-associated antigens (HLA-ABC, HLA-DR, vimentin, desmin, talin), extracellular matrix components (chondroitin sulfate, fibronectin, laminin, vitronectin, hyaluronic acid), elastin, and collagen type VII was dramatically reduced or absent from ADMs prepaed by both methods. However, significant amounts of elastin, keratan sulfate, laminin, and collagen types III and IV were still observed in both ADMs. Both methods of ADM preparation resulted in extensive extraction of both cellular and extracellular components of the skin but retention of the basic dermal architecture. In general, ADM prepared by the NaCl-SDS method retained larger amounts of each antigen than did that prepared by the Dispase-Triton method. This was most evident for laminin and type VII collagen but larger amounts of type IV collagen, fibronectin, desmin, elastin, and HLA-DR were also evident in the NaCl-SDS ADM.