The Surgical Use of Aseptically Processed Human Allografts* to Achieve Maximal Function in Complex Wound Closure

Introduction; Achieving closure in complex wounds can be challenging. They are typically found in patients with multiple co-morbidities, which can result in a suboptimal wound bed characterized by poor vascularization, inflammation, and chronic infection. Aseptically processed human allograft tissue without terminal sterilization can provide the native structure and properties to support organized remodeling and closure over time.

Specifically, meshed human reticular acellular dermal matrix (HR-ADM) has an open, uniform 3D structure that supports cell infiltration and tissue ingrowth. In addition, allograft adipose matrix (AAM) can be used to support host adipose ingrowth and supplement native cushioning. Dehydrated human amnion/chorion allograft (dHACA) has preserved matrix proteins, which help with natural closure of wounds.

Methods: This study presents three cases treated with allograft tissue forms. The staged approach included debridement and placement of meshed HR-ADM to improve the wound bed for skin grafting in two cases and to also fill the dead space of a tunneling wound another case. During this time, negative pressure wound therapy (NPWT) was also utilized to facilitate graft integration. A few days later, a split thickness graft was applied to two of the cases, whereas, AAM was injected to re-create contour and bulk in the area followed by dHACA to optimize the wound bed before the use of STSG in another case.

Results: Prior to skin grafting, the meshed HR-ADM was completely incorporated in each of the cases. The use of allograft tissue in these three cases allowed these large, deep, complex wounds to heal within a matter of weeks with excellent functional results.

Conclusion: These cases demonstrate that aseptically processed human allografts without terminal sterilization help support wound remodeling and wound closure activities, which ultimately lead to improved clinical outcomes.