Aseptically Processed Meshed Reticular Acellular Dermal Matrix A Step-Wise Approach to Venous Stasis Ulcers

Introduction: Venous Stasis Ulcers are challenging for the wound care clinician and surgeon. Wound bed preparation, which is necessary for successful skin grafting and durable coverage, remains the goal of therapy. We suggest that while allografts have been used to assist with secondary healing or as an alternative to an autologous skin graft, perhaps an allograft that incorporates into the tissue may allow the benefit of both.Aseptically processed meshed reticular acellular dermal matrix is unique in that it comes from the reticular dermal layer that provides an open network structure to support tissue ingrowth and serve as a scaffolding.

Methods/Results: We present 3 cases of venous stasis ulcers refractory to wound therapy. All were managed as a staged approach to include debridement, placement of meshed reticular dermal matrix, and autologous skin grafting. Following surgical debridement, negative pressure wound therapy with instillation and dwell time (NPWTi d*) was utilized for 2-7 days.

The patients were then treated with meshed reticular dermal allograft to serve as a scaffolding for an autologous graft. Following 6 weeks of NPWT, autologous grafting was performed. At the time of grafting, the meshed reticular dermal graft was completely incorporated into the host tissue with a reduction in wound depth with complete coverage of the deep tissue including bone and tendon. NPWT was placed for 7-10 days post grafting. In all cases there was 100% skin graft take with wounds healed completely with minimal depth and soft tissue deformity.

Discussion: Meshed reticular acellular dermal matrix has properties that allow tissue integration and incorporation. Patients with venous stasis ulcers may benefit from aseptically processed meshed allograft to help create a scaffolding to help optimize successful autologous skin grafting particularly when bone or tendon is exposed.