Strategies for Extremity Reconstruction with Exposed Bones and Tendons Using Acellular Dermal Matrices: Concept of Sequential Vascularization

Successful take of skin grafts requires a well vascularized wound bed, and remain challenging when performed over poorly vascularized structures, such as exposed bones and tendons. The advent of acellular dermal matrices (ADMs) has provided new opportunities for vascular ingrowth and subsequent graft take. In a two-stage strategy, ADMs allow vascularization of the wound bed over a few weeks leading to successful split-thickness skin grafts, particularly over challenging wounds such as with exposed structures. We report 4 cases of patients treated with ADMs (Integra LifeSciences) over exposed structures, highlighting the power of ADMs for such conditions.

Patient 1 (34 yo male, smoker) with soft tissue injury to thigh and foot was treated with Bilayer Wound Matrix. Patient 2 (65 yo male) with achilles tendon repair was treated with Flowable Wound Matrix and Bilayer Wound Matrix. Patient 3 (65 yo male, smoker) with index finger down to bone, no periosteum was treated with Bilayer Wound Matrix. Patient 4 (48 yo female, Moyamoya disease, mental disabilities) with open wounds on the foot was treated with Wound Matrix Thin Skin and Bilayer Wound Matrix.

A two-stage procedure was performed on all patients, except for patient 3 who was subject to only the layering of the AMD. Patients 1, 2, 3 and 4 elicited full re-epithelialization and range of motion after 9, 24 12 and 13 weeks, respectively.

ADMs are integral part of the reconstructive armamentarium. Results from these 4 cases highlight the power of dermal matrices for treating challenging wounds with exposed structures. By providing sequential vascularization, ADMs allow more difficult areas with poor vascularity to be covered from the “inside-out”. ADMs, in contrast to skin graft, are not “time sensitive” and live “over time”.

Trademarked Items (if applicable): Integra

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