The Use of Aseptically Processed Meshed Reticular Acellular Dermal Matrix* in Soft Tissue Necrotizing Infection
Speaker: Michael N. Desvigne, MD, FACS, CWS, FACCWS
Summary
Soft tissue necrotizing infections 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 in-corporates into the tissue may allow the benefit of both.
Aseptically processed meshed human reticular acellular dermal matrix (HR-ADM) is unique in that it comes from the reticular dermal layer that provides an open network structure to sup-port tissue ingrowth and serve as a scaffolding.
Methods
We present 2 cases of soft tissue necrotizing infection. One involving the lower extremity and the other involving the perineum, Forniers Gangrene. Both were managed as a staged approach to include debridement, placement of meshed HR-ADM, 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 HR-ADM to serve as a scaffolding for an autologous graft. Following 1-6 weeks of NPWT, autologous graft-ing was performed. At the time of grafting, the meshed HR-ADM was completely incorporated into the host tissue in 1 patient. The other patient underwent autologous grafting at 1 week with partial autologous graft loss. However, the wound achieved a reduction in size and depth with complete secondary healing over a 3-month period, without the need for additional surgi-cal intervention.
Conclusion
Meshed HR-ADM has properties that allow tissue integration and incorporation. Patients with soft tissue necrotizing infection require wound bed preparation with multiple debridements. Following wound bed optimization, these patients may benefit from aseptically processed meshed allograft to help create a scaffolding to help optimize successful autologous skin graft-ing and/or allow for secondary healing, even with as a primary or secondary option if autolo-gous grafting is unsuccessful.
