Single-stage Extremity Reconstruction through the Use of Acellular Dermal Matrices: the Power of Dermal Matrices in the Face of Patient Preference or Extreme Non-compliance

The use of acellular dermal matrices (ADMs) in extremity reconstruction often involve two-stage reconstruction. Two-stage procedures are generally conducted on patients with large defects who would benefit from a secondary skin graft. Such procedures require the patients to undergo two surgical procedures and necessitate patient compliance. If possible, single-stage procedures, through re-epithelialization, offer the opportunity to avoid multiple operations and reduce donor-site morbidity. We report 4 cases of patients treated with ADMs with the aim to perform two-stage procedures. Either patient preference or extreme non-compliance led to re-epithelialization of the wounds.

Patient 1 (80 yo female) with open fracture 4th metacarpal and dorsal hand soft tissue loss. Patient 2 (53 yo male, IV drug abuser) with right upper extremity necrotizing fascitis. Patient 3 (65 yo male, smoker) with table saw injury to dorsal 2nd and 3rd fingers. Patient 4 (62 yo male, medical comorbidities) with diabetic ketoacidosis and necrotizing fasciitis. All patients were treated with Bilayer Wound Matrix or PriMatrix (Integra LifeSciences) with the aim to conduct two-stage procedures. For reasons related to patient preference or extreme non-compliance, each of these patients did not have a secondary reconstructive procedure.

Patients 1 and 3 chose not to have secondary reconstruction. Patients 2 and 4 left hospital with no follow-up until 3 and 6 months after, respectively. All 4 patients returned eventually for long-term follow-up and reported excellent re-epithelialization with either complete healing or healthy near complete healing with single-stage reconstruction alone.

ADMs are integral part of the reconstructive armamentarium. Results from these 4 cases highlight the power and resilience of dermal matrices in the face of medical co-morbidities, patient preference and extreme non-compliance. Single-stage procedures remove the reliance on patient compliance in the reconstructive algorithm, a welcome finding in difficult patient populations.

Trademarked Items (if applicable): Integra, PriMatrix

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