Use Of Acellular Dermal Matrix Research Articles

ASO Visual Abstract: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomised Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM.

ASO Visual Abstract: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomised Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM.

Case-matched Comparison of Implant-based Breast Reconstruction with and without Acellular Dermal Matrix.

Acellular dermal matrix (ADM) is commonly used in implant-based breast reconstruction due to improved soft-tissue support and control of the implant pocket and decreased capsular contracture. However, concerns about complications have prompted the FDA to request more clinical data. This large-scale study aims to examine perioperative outcomes of ADM use in breast reconstruction. This study utilized a national insurance-based database to identify patients who underwent mastectomy between 2011 and 2019, with and without ADM. The groups were matched for age, region, and comorbidities. Complications within 90 days were compared using univariate and multivariate analyses. A total of 49,366 patients were identified with 26,266 patients in the ADM group and 23,100 in the non-ADM group. Infection rates (4.7% ADM versus 4.4% no ADM) and seroma rates (3.9% ADM versus 4% no ADM) were similar. However, the ADM group had a 1% higher rate of implant removal (4.9% ADM versus 3.9% no ADM, P < 0.001). In direct-to-implant procedures, ADM use was associated with higher explantation rates (8.2% versus 6.3%, P = 0.002). Multivariate analysis identified tobacco use, hypertension, depression, obesity, ADM usage, and direct-to-implant surgery as risk factors for implant removal. This study found comparable infection and seroma rates in implant-based breast reconstruction with and without ADM. ADM use was associated with a 1% higher risk of implant removal, with risk factors including tobacco use, obesity, hypertension, depression, and direct-to-implant procedures. Multicenter studies and registry data on prepectoral breast reconstruction are warranted to help interpret these findings.

Review: Implant-Based Breast Reconstruction After Mastectomy for Breast Cancer: A Meta-analysis of Randomized Controlled Trials and Prospective Studies Comparing Use of Acellular Dermal Matrix (ADM) Versus Without ADM.

Breast cancer is the world's most prevalent cancer, and many breast cancer patients undergo mastectomy as the choice of treatment, often with post-mastectomy breast reconstruction. Acellular dermal matrix (ADM) use has become a method to improve outcomes of reconstruction for these patients. We aimed to compare postoperative complications and patient-reported outcomes, which are still poorly characterized, between groups utilizing acellular dermal matrix during reconstruction and those without. We searched electronic databases from inception to 16 June 2022 for randomized controlled trials and prospective cohort studies comparing the outcomes of patients who have and have not received acellular dermal matrix in implant-based breast reconstruction. The results were quantitatively combined and analyzed using random-effects models. A total of nine studies were included, representing 3161 breasts. There was no significant difference in postoperative outcomes, such as seroma formation (p = 0.51), hematomas (p = 0.20), infections (p = 0.21), wound dehiscence (p = 0.09), reoperations (p = 0.70), implant loss (p = 0.27), or skin necrosis (p = 0.21). Only two of the studies included evaluated patient-reported outcomes between the use and non-use of ADM in implant-based breast reconstruction using BREAST-Q questionnaire, as well as self-reported pain. There was no reported significant difference in BREAST-Q or pain scores. This meta-analysis shows comparable short- and long-term outcomes between ADM and non-ADM breast reconstruction, suggesting that the use of ADM may not be necessary in all cases given their additional cost. However, there is a paucity of data for patient-reported outcomes, and further research is required to determine whether ADM use affects patient-reported outcomes.

Meshed Dermal Sling for Prepectoral Breast Reconstruction.

The best breast reconstruction solution after mastectomy remains a topic of wide debate. Recently, the focus in the field of implant-based reconstruction has been on the increasing indications for prepectoral reconstruction. This offers undoubted advantages over subpectoral reconstruction, ranging from better aesthetic results and patient comfort to a less invasive procedure that spares the pectoralis major muscle, reducing pain and postoperative recovery time. The dermal sling is a reconstructive variant introduced by Bostwick in the 1990s and is commonly used to complete the subpectoral pocket in one- or two-stage reconstruction, creating a dual-plane reconstruction. This method may be indicated after mastectomy for both therapeutic and prophylactic purposes. It can also be used for unilateral and bilateral reconstructions. We propose a new meshed dermal sling technique that allows complete prepectoral reconstruction without the use of acellular dermal matrix, thus reducing the cost of reconstruction. It also allows the indication for complete prepectoral reconstruction to be extended to patients with medium breast volume and grade 1 or 2 ptosis, without the need to use acellular dermal matrix or the pectoralis major muscle to complete the breast pocket.

Outcomes after tissue expander exchange to implant in two-stage prepectoral breast reconstruction with and without acellular dermal matrix: A retrospective cohort study

As prepectoral implant placement becomes widely adopted, recent studies investigating the use of acellular dermal matrix (ADM) during tissue expander placement have demonstrated no major benefit with regard to postoperative outcomes. We sought to evaluate second-stage outcomes 1 year after tissue expander exchange to implant with and without ADM. Consecutive patients who underwent prepectoral tissue expander-based breast reconstruction with and without ADM were identified. Patients were followed up for 1 year after tissue expander exchange to implant. Second-stage outcomes of interest including implant rippling, capsular contracture, implant explantation, additional revision surgeries, and patient-reported outcomes were collected and compared. Sixty-eight breasts in the ADM cohort and sixty-one breasts in the no ADM cohort underwent tissue expander exchange to implant. Second-stage outcomes of interest were similar between the ADM and no ADM cohorts with no statistically significant differences identified regarding incidences of implant rippling (24.6% vs. 12.1%, p=0.08), capsular contracture (4.5% vs. 3.3%, p=1.00), and explantation (6.6% vs. 1.7%, p=0.67) between the two cohorts. BREAST-Q scores were similar between the two cohorts with the exception of physical wellbeing and satisfaction in terms of implant rippling, as can be seen, which improved in the no ADM cohort (p=0.04). Our study reports no major benefit for the inclusion of ADM with respect to implant rippling, capsular contracture, explantation, need for additional revision surgeries, and patient-reported satisfaction in prepectoral second-stage implant-based breast reconstruction.

Does the dominant hand’s use affect the complication rates in prosthetic breast reconstruction?

Background Numerous studies have investigated risk factors for unfavorable outcomes in prosthetic breast reconstruction, such as obesity, perioperative radiotherapy, and acellular dermal matrix use. However, no reports have explored whether the use of the dominant hand influences complications in breast reconstruction. To address this gap in the literature, analyzed complication rates between the dominant and non-dominant sides after reconstruction.Methods We retrospectively reviewed the charts of 160 patients (170 breasts) who underwent breast reconstruction from February 2017 to March 2022. We analyzed the complications between beasts on the dominant and non-dominant sides according to the reconstruction method.Results During prosthetic breast reconstruction, the drainage volume and duration on the dominant side exceeded those on the non-dominant side after reconstruction (duration: 9.79 days on the dominant side vs. 9.12 days on the non-dominant side, P=0.196; volume: 771.1 mL on the dominant side vs. 654.3 mL on the non-dominant side, P=0.027). The incidence of complications such as wound dehiscence, mastectomy flap necrosis, and infection was significantly higher in the dominant hand group (infection: 6 vs. 0, P=0.014; dehiscence: 15 vs. 4, P=0.009; flap necrosis: 13 vs. 4, P=0.024).Conclusions Complications including seroma, infection, and mastectomy skin flap necrosis following prosthetic reconstruction were common in breasts on the dominant-hand side. Therefore, meticulous management and restriction of shoulder movement can aid in preventing seroma-related complications in prosthetic breast reconstruction, especially on the side of the dominant hand.

Root coverage using modified tunneling technique with acellular dermal matrix for treatment of gingival recession associated with orthodontic treatment: A case report

Background: Gingival recession has a number of causes, including orthodontic therapy. The degree and extent of gingival recession and orthodontic therapy are strongly correlated. Care must be taken in choosing the best soft tissue grafting technique. Development of a number of new and improved surgical techniques, including the modified tunneling technique. Case Management: A-24-year-old female patient came to Periodontic Clinic Dental Hospital of Airlangga University with a chief complain of gingival recession in mandibular central incisors since 6 months ago. The patient complained about dental sensitivity. The dental history revealed that she had undergone fixed orthodontic therapy for 7 years. She revealed the fixed orthodontic appliance was put off since 8 months ago. The patient concern about her appearance and aesthetic problem. Gingival recession on buccal surface tooth 31 and 41 extending 1,5-2 mm apical of the incisors was found in clinical assessment. This case classified as Miller class III. The doctor planned root coverage procedure using modified tunnel technique. Acellular dermal matrix (Surederm®) was chosen as a gingival graft. Discussion: Creating a "tunnel" through the buccal mucosa to treat gingival recession enables coronal repositioning of the soft tissue with predictable root coverage and a pleasing appearance. Tissue graft implantation is made possible by a horizontal incision. Conclusion: In brief, root coverage using modified tunnel technique is effective and predictable treatment modality. Comparing with other root coverage method it give quite satisfying result. The use of Acellular Dermal Matrix (ADM) considered as an alternative to Connective Tissue Graft (CTG).

Acellular Collagen Matrix Patch Augmentation of Arthroscopic Rotator Cuff Repair Reduces Re-Tear Rates: A Meta-analysis of Randomized Control Trials

To perform a meta-analysis of randomized controlled trials (RCTs) to compare the outcomes of arthroscopic rotator cuff repair (ARCR) with and without acellular collagen matrix patch (ACMP) augmentation. A literature search of 3 databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RCTs comparing ACMP augmentation and a control for ARCR were included. Clinical outcomes were compared using Revman, and a P value < .05 was considered to be statistically significant. Five RCTs with 307 patients were included. Overall, 11% of patients treated with ACMP augmentation and 34% of patients in the control group had a re-tear (P= .0006). The mean Constant score was 90.1 with ACMP augmentation, and 87.3 in controls (P= .02). Additionally, there was a significant higher American Shoulder and Elbow Surgeons score with ACMP augmentation (87.7 vs 82.1, P= .01). The RCTs in the literature support the use of ACMP augment as a modality to reduce re-tear rates and improve outcomes after ARCR. Level II, Meta-Analysis of Level II Studies meta-analysis of Level II studies.

Acellular Dermal Matrix without Basement membrane in Immediate Prepectoral Breast Reconstruction: A Prospective, Randomized Controlled Trial

Background: The acellular dermal matrix (ADM) has become popular in various reconstructive surgeries of different regions. There are different needs depending on the clinical applications including breast, abdominal wall, and any other soft tissue reconstruction. Removal of the basement membrane (BM), which consists of collagen fibers, may help achieve natural and soft breast reconstruction that require highly elastic ADMs. Given the lack of knowledge of the effectiveness of the ADM without the BM, we compared the clinical outcomes of ADMs with and without BM in breast reconstruction. Methods: We conducted a prospective, single-blinded, randomized controlled trial to evaluate differences in clinical outcomes. The patients were randomized into ADM with BM and without BM groups. Both groups underwent immediate prepectoral direct-to-implant breast reconstruction. Demographics, surgical outcome, and breast shape change using nipple position were compared between the two groups. Results: A total of 56 patients were divided into two groups: ADM with BM (n=30, 53.6%) and ADM without BM (n=26, 46.4%). Clinical and surgical demographics were similar between the two groups. The authors detected no statistically significant differences in the overall rate of complications and breast shape change between the two groups. However, the rate of seromas was higher in the ADM with BM group than that in the ADM without BM group (10% vs. 0%, P=0.09). Conclusion: The two groups showed similar surgical outcomes. The use of ADM without BM in implant-based breast reconstruction was safe with its mechanical properties of lower tensile strength and higher elasticity.

When to Consider Prepectoral Implant Conversion After Subpectoral Implant Breast Reconstruction and How to Plan It.

Many deformities occur after subpectoral implant-based breast reconstruction. Today, immediate prepectoral reconstruction with implants shows a significant increase in popularity as it has many advantages over subpectoral positioning: absence of muscle deficit, breast animation, reduced implant dislocation, less postoperative pain and easy recovery. As such, implant pocket conversion from the submuscular to prepectoral plane has become our preferred strategy for solving most problems related to the submuscular implant position. The authors performed a retrospective review (from June 2018 to December 2022) of patients who underwent prepectoral implant conversion for the correction of animation deformity, dysfunctional chronic pain, and to ameliorate poor cosmetic results. The use of acellular dermal matrix (ADM) was done in the first 7 cases, in the remaining 56 were used polyurethane-covered implants. Resolution of animation deformity, chronic pain was evaluated in addition to cosmetic results and the onset of postoperative complications. Sixty-three patients (87 breasts) underwent prepectoral implant conversion with complete resolution of animation deformity, chronic pain and improved cosmetic results. Preventive lipofilling was done in 18 patients. Complication rate included 3 periprosthetic seroma in ADMs group. All were solved after US-guided aspiration. Rippling was noted in 3 patients and edge visibility was documented in 1 patient. There are no incidences of grade III and IV capsular contracture. The prepectoral implant conversion improves functional and aesthetic results, reaching excellent outcomes. The preparation for this surgery with fat graft is considered a complementary procedure that increases the indications for prepectoral implant conversion.

Acellular Dermal Matrix, Osseoplastic Flap, and Transnasal Endoscopic Approach for Frontal Mucocele.

The primary objective of this study is to suggest the use of acellular dermal matrix through an osteoplastic flap and transnasal endoscopic treatment for the management of frontal mucoceles. The secondary objective is to propose the characteristics to choose this approach. A retrospective cohort study was carried out on patients with frontal mucoceles of different etiologies where an osteoplastic flap was made to address the sinus and subsequently obliterated with acellular dermal matrix. A cohort of 11 patients were included in the study, 6 (67%) were female and 5 (56%) were male, with a mean age of 56 years (range 35-71). The majority of patients (73%) with a history of trauma and all the patients were treated with frontal osteoplastic flap and obliteration with acellular dermal matrix. No evidence of recurrence in a follow-up period with a mean of 18 months and a low rate of complications. The frontal osteoplastic flap and obliteration with acellular dermal matrix is a simple and safe technique to perform with low morbidity. Also, an orbital reconstruction can be performed simultaneously.

The use of fetal bovine acellular dermal matrix for management of chronic wounds

Aims: In the treatment of chronic wounds, tissue growth must be addressed and optimized. The purpose of this study is to investigate the use of the regenerative medicinal product Fetal Bovine Acellular Dermal Matrix (FBADM) in chronic wounds. &#x0D; Methods: The patients were chosen sporadically and randomly based on availability to FBADM. Patients were assessed for adequate perfusion, debridement was performed, and wounds were ensured to be free of infection. FBADM was placed in the wound bed covered with a non-adherent contact layer, and a hydrogel sheet was placed to maintain adequate moisture. Offloading or compression was used as clinically indicated. Patients were then followed weekly. Digital photography was used to visually document healing progress. &#x0D; Results: After 1-3 weeks wounds managed with FBADM had improved characteristics and healthy vascularized tissue that subsequently epithelialized from wound margins or grafted with split thickness skin grafts. Of the 14 wounds we achieved 69% complete healing, 24% non-complete healing after 12 weeks of FBADM application. 7% of the wounds needed skin graft surgery.&#x0D; Conclusion: We found FBADM to be useful for treatment regimen of diabetic foot and leg ulcers, venous leg ulcers, surgical wounds, and wounds being prepared for skin grafting.

Prepectoral Two Stage Implant-Based Breast Reconstruction with Poly-4-Hydroxybutyrate (P4HB) for Pocket Control without the use of Acellular Dermal Matrix (ADM): A 4-Year Review.

As an alternative to biologic materials, absorbable meshes have been utilized to mitigate the potential drawbacks of ADM based breast reconstruction. Poly-4-hydroxybutyrate has been demonstrated to be a lower cost, safe, and effective alternative to ADM in subpectoral breast reconstruction. The aim of this study is to present the largest long-term observational study to date using P4HB for pocket control and implant support in immediate two stage pre-pectoral breast reconstruction looking at non-integration, capsular contracture, and implant malposition, along with patient comorbidities and risk factors. A retrospective review of a single surgeon's (KM) experience was performed over a 4year span for patients who had undergone immediate two-stage prepectoral implant-based breast reconstruction with P4HB mesh. The review examined complications including implant loss, rippling, capsular contracture, malposition, and patient satisfaction throughout follow up. From 2018 to 2022, 105 patients underwent breast reconstruction using P4HBmesh for a total of 194 breasts. P4HBmesh integration was 97%. Overall, 16 breasts (8.2%) experienced minor complications while 10.3% of devices required explantation which was significantly higher in the radiated group at 28.6% (P<0.01). Older patients, higher BMI, active smokers, or increased mastectomy specimen size were more likely to undergo explantation. The rate of capsular contracture was 1.0 %. The overall rate of lateral malposition was also 1.0%. Visible rippling was present in 15.6% of breasts. There was no significant difference between smile mastopexy and inferolateral incision with regards to capsular contracture, lateral malposition, or rippling. Overall, patients demonstrated a high level of satisfaction and there were no significant predictors of capsular contracture, lateral malposition, or visible rippling. We have shown the safety and efficacy of P4HB in 2-stage pre-pectoral breast reconstruction. There appears to be equal, if not reduced, capsular contracture rates when compared to the published data on the use of ADM. Lastly, this represents a large cost reduction to both the patient and health care system.

Attenuating Chronic Fibrosis: Decreasing Foreign Body Response with Acellular Dermal Matrix.

Surgical implants are increasingly used across multiple medical disciplines, with applications ranging from tissue reconstruction to improving compromised organ and limb function. Despite their significant potential for improving health and quality of life, biomaterial implant function is severely limited by the body's immune response to its presence: this is known as the foreign body response (FBR) and is characterized by chronic inflammation and fibrotic capsule formation. This response can result in life-threatening sequelae such as implant malfunction, superimposed infection, and associated vessel thrombosis, in addition to soft tissue disfigurement. Patients may require frequent medical visits, as well as repeated invasive procedures, increasing the burden on an already strained health care system. Currently, the FBR and the cells and molecular mechanisms that mediate it are poorly understood. With applications across a wide array of surgical specialties, acellular dermal matrix (ADM) has emerged as a potential solution to the fibrotic reaction seen with FBR. Although the mechanisms by which ADM decreases chronic fibrosis remain to be clearly characterized, animal studies across diverse surgical models point to its biomimetic properties that facilitate decreased periprosthetic inflammation and improved host cell incorporation. Impact Statement Foreign body response (FBR) is a significant limitation to the use of implantable biomaterials. Acellular dermal matrix (ADM) has been observed to decrease the fibrotic reaction seen with FBR, although its mechanistic details are poorly understood. This review is dedicated to summarizing the primary literature on the biology of FBR in the context of ADM use, using surgical models in breast reconstruction, abdominal and chest wall repair, and pelvic reconstruction. This article will provide readers with an overarching review of shared mechanisms for ADM across multiple surgical models and diverse anatomical applications.

An Evaluation of Early Complications after Prepectoral Tissue Expander Placement in First-Stage Breast Reconstruction with and without Acellular Dermal Matrix.

Prepectoral breast reconstruction has become popularized with the concurrent use of acellular dermal matrix (ADM). We sought to compare three-month postoperative complication rates and explantation rates for first stage, tissue expander based prepectoral breast reconstruction with and without the use of ADM. A single institution retrospective chart review was performed to identify consecutive patients undergoing prepectoral tissue-expander based breast reconstruction from August 2020 to January 2022. Chi-squared tests were used to compare demographic categorical variables and multiple variable regression models were used to identify variables associated with three-month postoperative outcomes. We enrolled 124 consecutive patients. Fifty-five patients (98 breasts) were included in the no-ADM cohort and 69 patients (98 breasts) were included in the ADM cohort. There were no statistically significant differences between ADM and no-ADM cohort in regard to 90-day postoperative outcomes. On multivariable analysis, there were no independent associations between seroma, hematoma, wound dehiscence, mastectomy skin flap necrosis, infection, unplanned return to the OR, or explanation in the ADM or no ADM groups after controlling for age, BMI, history of diabetes, tobacco use, neoadjuvant chemotherapy, and postoperative radiotherapy. Our results reveal no significant differences in odds of postoperative complications, unplanned return to the OR, or explantation between ADM and no-ADM cohorts. More studies are needed to evaluate the safety of prepectoral, tissue expander placement without ADM.

Direct-to-Implant, Prepectoral Breast Reconstruction: Geometric Breast Measurements and Changes at 2-Year Follow-Up.

Prepectoral breast reconstruction has recently experienced a resurgence in popularity. However, in direct-to-implant (DTI) reconstruction, there is no opportunity for capsular modifications before final implant insertion. Implant pocket and breast shape are thus maintained, initially, solely by the mastectomy skin flaps, and eventually, by attachments of the periprosthetic capsule. The present study aims to quantify changes in breast geometric measurements over time following DTI prepectoral breast reconstruction. A retrospective chart review was performed for patients who underwent bilateral prepectoral DTI reconstruction performed by a single surgeon from June of 2016 to January of 2018. Patients followed for more than 2 years were included. Yearly standardized frontal photographs were analyzed, and nipple-to-midline, sternal notch-to-nipple, and midclavicle-to-lower pole measurements were obtained. Patient demographics, operative details, and complications were documented. A total of 72 breasts (38 women) undergoing direct-to-implant, prepectoral breast reconstruction were included in the final analysis. Acellular dermal matrix was used in 56 breasts only (78.9%) for anterior coverage. The average change in nipple-to-midline distance after 2 years decreased by 0.41 cm (range, -2.00 to 2.97 cm), sternal notch-to-nipple distance decreased by 0.62 cm (range, -4.98 to 5.4 cm), and midclavicle-to-lower pole distance decreased 0.10 cm superiorly (range, -6.07 to 3.6 cm). In breasts that underwent postmastectomy radiation therapy, the average changes were -0.08, -0.43, and -0.56 cm, respectively. No patient in this cohort had severe malposition requiring further surgery. The present study provides insight into geometric breast measurements following prepectoral breast reconstruction at 2-year follow-up. The minimal breast shape changes observed demonstrate the feasibility of prepectoral DTI reconstruction with or without the use of acellular dermal matrix. Therapeutic, IV.

Early Complications in Prepectoral Breast Reconstructions with and without Acellular Dermal Matrix: A Preliminary Analysis of Outcomes.

Prepectoral tissue expander (TE) placement for two-stage postmastectomy reconstruction is usually performed in conjunction with insertion of acellular dermal matrix (ADM). However, the effects of ADM use on TE loss or other early complications remain unknown. Therefore, the aim of this study was to compare early postoperative complications in patients who underwent prepectoral breast implant reconstruction with or without ADM use. The authors performed a retrospective cohort study of all patients at their institution who underwent prepectoral breast reconstruction from January of 2018 to June of 2021. The primary outcome was TE loss within 90 days of surgery; secondary outcomes included other complications such as infection, TE exposure, mastectomy skin flap necrosis requiring revision, and seroma. Data on 714 patients with 1225 TEs (1060 with ADM and 165 without) were analyzed. Baseline demographics did not differ by ADM use, although mastectomy breast tissue weight was higher in patients without ADM (750.3 g versus 540.8 g; P < 0.001). Rates of TE loss were similar in reconstructions with (3.8%) ADM and without (6.7%; P = 0.09). We also did not find differences in the rates of secondary outcomes between cohorts. ADM use had no statistically significant effect on early complication rates among patients undergoing breast reconstruction with prepectoral TEs. Still, this study was underpowered, and data trended toward statistical significance; thus, larger studies are required in the future. Additional research and randomized studies should focus on larger cohorts and examine long-term complications such as capsular contracture and implant malposition. Therapeutic, III.

Acellular Dermal Matrix Cover Improves Skin Growth during Tissue Expansion by Affecting Distribution of Mechanical Forces.

Biological cover over tissue expander prostheses has been introduced to provide soft-tissue support for tissue expanders during breast reconstruction. However, its impact on mechanically induced skin growth remains unknown. This study investigates the hypothesis that covering the tissue expander with acellular dermal matrix (ADM) affects mechanotransduction without compromising the efficacy of tissue expansion. Tissue expansion, with and without use of ADM, was performed on a porcine model. The tissue expanders were inflated twice with 45 mL of saline, and the full-thickness skin biopsy specimens were harvested from expanded and control unexpanded skin 1 week and 8 weeks after the final inflation. Histologic evaluation, immunohistochemistry staining, and gene expression analysis were performed. Skin growth and total deformation were evaluated using isogeometric analysis. The authors' results demonstrate that use of ADM as a biological cover during tissue expansion does not impede mechanotransduction that leads to skin growth and blood vessel formation. Isogeometric analysis revealed similar total deformation and growth of expanded skin with and without a biological cover, confirming that its use does not inhibit mechanically induced skin growth. In addition, the authors found that use of an ADM cover results in more uniform distribution of mechanical forces applied by the tissue expander. These results suggest that ADM improves mechanically induced skin growth during tissue expansion by facilitating a more uniform distribution of mechanical forces applied by the tissue expander. Therefore, the use of a biological cover has potential to improve outcomes in tissue expansion-based reconstruction.

The Use of Acellular Dermal Matrix for the Closure of Skin Defects

Background &amp; Objectives: Skin substitutes are a diverse set of biologics, synthetics, and biosynthetic materials that can replace open skin wounds temporarily or permanently. Skin substitutes are designed to mimic the qualities of natural skin. One must select an option that accomplishes an excellent wound healing and closure. This study aimed to assess the reliability and effectiveness of ?acellular dermal matrix for potentially more pliable coverage of the wound and for better ?functional and aesthetic appearance of the skin defects. Methods: A prospective cohort study performed on 20 patients with full-thickness skin defects who underwent surgery using acellular dermal substitute and skin grafting in Erbil Governorate from January 2017 to December 2019. Functional and aesthetic outcome has been evaluated in this study. Results: The study included 20 patients with mean age of 18.8 ± 6.2 years, female to male ratio was 1.5:1, and the majority of the cases presented with burn (90%). The Vancouver Scar Scale score was significantly reduced after 1 month of follow-up in which it reduced by 4.12 mm (57.6% reduce from baseline), Mean healing score was 93.5%, and Re-epithelialization after 1 month Was 95.55%, Overall the complication rate is low with 5% had hematoma, 5% had infection and 5% had loss of graft. Conclusion: The use of acellular dermal matrix in conjunction with split thickness skin graft result in substantial improvement in the quality of wound healing and tissue reconstruction.

A load sharing principle in abdominal wall reconstruction follow-up &amp; case report: Strattice biologic mesh without the presence of adhesions

Background: The senior authors previously published a paper on abdominal wall reconstruction using Strattice acellular dermal matrix demonstrating effective aesthetic and functional results. Despite the common and effective use of Strattice acellular dermal matrix for abdominal wall reconstruction, insurance companies do not universally approve its usage. Critics of its usage state that its intra-abdominal effects are unknown. Purpose: To further demonstrate that Strattice acellular dermal matrix is a safe and durable method to reconstruct the abdominal wall with maximal outcomes, minimal intra-abdominal morbidity, and adhesion formation. Methods: A retrospective chart review was done on our patient who underwent abdominal wall reconstruction of a ventral hernia with component separation and placement of Strattice acellular dermal matrix several years prior. The patient happened to develop appendicitis several years post abdominal wall reconstruction, requiring laparoscopic appendectomy. Photographic analysis was used to document the Strattice and absence of adhesions. Results: Strattice acellular dermal matrix was successfully used in the underlay intra-abdominal position to reinforce a midline hernia repair and external oblique component separation. At three years post hernia repair, the patient had no evidence of hernia. CT-scan demonstrated well opposed rectus abdominus muscles. On laparoscopic examination of the intraperitoneal cavity during appendectomy, there was no evidence of bowel adhesions to the abdominal wall or Strattice acellular dermal matrix. The Strattice was lined with peritoneum. Conclusion: Successful repair of primary and recurrent abdominal hernia with Strattice acellular dermal matrix is effective. In our experience, the production of adhesions between the bowl and the intraperitoneal placed Strattice is low.