Use of Aseptically Processed Placental Allograft and Meshed Reticular Acellular Dermal Matrix as Wound Bed Stabilizer and Scaffolding to Support Deep Soft Tissue Reconstruction

Introduction: Trauma to the extremities represents one of the most common injury forms leading to large, full thickness soft tissue loss. Achieving closure after extensive debridement of necrotic tissue can be challenging, especially in patients with multiple co-morbidities. The suboptimal wound bed can exhibit poor vascularization, inflammation and potential for infection. Aseptically processed dehydrated placental mini-membrane allografts provide preserved matrix proteins and growth factors, while meshed aseptically processed human reticular acellular dermal matrix (HR-ADM) can provide an open network structure to support host tissue ingrowth. Two cases are presented where dehydrated placental mini-membrane and HR-ADM are used to rebuild deep soft tissue loss in traumatic injuries.Methods:Case 1 is a 60 year-old female, hit and dragged by a snowplow truck. She suffered a circumferential right lower extremity full thickness injury, with exposed periosteum and muscle. Case 2 is a 67 year-old male, injured from a tombstone slab, with right humerus fracture, ruptured extensors tendons, and full thickness loss in the antecubital area. Both cases were treated in staged approach, including debridement, and application of dehydrated placental mini-membrane and meshed HR-ADM with negative pressure wound therapy (NPWT) to stabilize the wound bed. Skin grafting and NPWT was done a week later for the hospitalized first patient and three weeks later for second patient in the clinic setting.Results:Granulation and vascularization were observed with complete integration of the HR-ADM in both cases. The healthy wound bed supported durable skin graft take and the injuries closed at 4-5 weeks. They remained stable, without signs of graft contracture or decreased range of motion.Discussion: Patients with full thickness soft tissue loss requiring skin grafts may benefit from a one-time application of meshed HR-ADM. The addition of placental allograft in difficult wounds helps stabilize the wound bed via preserved angiogenic, antimicrobial and anti-inflammatory properties. New regenerative therapies allow granulation and integration activities, added thickness and stabilization of the wound bed in preparation for skin grafting.References: