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Germano C, Borriello G, Corazzelli G, Abbate V, Troise S, Dell'Aversana Orabona G, Piombino P, Romano A, Collà Ruvolo C, Bonavolontà P. Mitigating complications rate in parotid gland tumor surgery by reconstruction technique with SurgiMend®: a retrospective, single-center, observational study on 300 consecutive patients. J Craniomaxillofac Surg 2025:S1010-5182(25)00141-6. [PMID: 40324913 DOI: 10.1016/j.jcms.2025.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/03/2025] [Accepted: 04/14/2025] [Indexed: 05/07/2025] Open
Abstract
BACKGROUND Salivary gland tumors have an incidence of 1 out of 100,000 people every year, representing 2-4 % of the head and neck tumors. Consensually, radical surgery is the choice in parotid tumors. Despite improvements in surgical and anatomy-preserving strategies, several complications exist in this surgery. Frey Syndrome is caused by an aberrant regeneration of parasympathetic nerve fibers of the auriculotemporal nerve after parotidectomy. PURPOSE The purpose of the present study was to compare the surgical complication rate differences between patients undergone parotid gland tumor surgery with reconstruction performed by traditional methods (Group A), and by SurgiMend (Group B). STUDY DESIGN, SETTING, AND SAMPLE The clinical, surgical, and monitoring data of 300 consecutive patients operated at our Institution between 2017 and 2020 were assessed for statistical deductive purposes, shaping a cohort retrospective monocentric observational study. PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE/MAIN OUTCOME VARIABLE The primary outcome variable was the rate of Frey Syndrome. Secondary outcomes were the other complication rates, including surgical site infections, dehiscence, hypertrophic scars, seromas, hematomas, and temporary and permanent facial nerve palsy. ANALYSES To conduct the statistical study, we used descriptive and deductive analyses. We employed the Fisher's Exact test for both analyses. All statistical tests were "two-tailed", and significance was set to an α-error <0.05. Statistical differences between groups A and B on the categorical postoperative complications were investigated for deductive purposes. RESULTS This study demonstrated the SurgiMend reconstruction to be significantly associated with a lower rate of Frey Syndrome and hypertrophic scar for parotid gland tumor surgery. CONCLUSION and relevance: Our study, through sustained and homogeneous follow-up on patients with benign tumors of the parotid gland, associated with a large, representative, and homogeneous sample, allows us to assert the genuineness and reliability of the minor Frey Syndrome and hypertrophic scars rates for benign parotid tumor surgery.
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Affiliation(s)
- Cristiana Germano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Republic of Italy
| | - Gerardo Borriello
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Republic of Italy.
| | - Giuseppe Corazzelli
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, "Federico II" University, Naples, Republic of Italy
| | - Vincenzo Abbate
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Republic of Italy
| | - Stefania Troise
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Republic of Italy
| | - Giovanni Dell'Aversana Orabona
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Republic of Italy
| | - Pasquale Piombino
- Maxillofacial Surgery Unit, "Sant'Anna e San Sebastiano" Hospital, Caserta, Republic of Italy
| | - Antonio Romano
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Republic of Italy
| | - Claudia Collà Ruvolo
- Unit of Urology, Department of Neurosciences, Sciences of Reproduction, and Odontostomatology, Federico II University, Via Pansini 5, 80100, Naples, Republic of Italy
| | - Paola Bonavolontà
- Maxillofacial Surgery Unit, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II, Via Pansini 5, 80100, Naples, Republic of Italy
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Lu H, Xu W, Zhu W, Wu Y, Yang W, Liu S. Functional reconstruction of tissue defects after total parotidectomy using a modified submandibular gland flap. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2025; 126:102022. [PMID: 39241830 DOI: 10.1016/j.jormas.2024.102022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2024] [Revised: 08/18/2024] [Accepted: 08/22/2024] [Indexed: 09/09/2024]
Abstract
OBJECTIVE Reconstruction of soft tissue defects after total parotidectomy requires a feasible and effective pedicled flap with sufficient volume. In this study, we introduce a modified submandibular gland flap (SMGF) for functional reconstruction of soft tissue defects resulting from total parotidectomy. MATERIALS AND METHODS This study included 12 patients diagnosed with parotid gland carcinoma undergoing total parotidectomy and ipsilateral selective neck dissection. The modified SMGF was harvested and transferred to the parotid bed. This procedure was coupled with anastomosis between the parotid gland duct and Wharton's duct. The feasibility of the surgery, postoperative complications, facial profile restoration, and salivary secretion were assessed. RESULTS All SMGFs pedicled only over the proximal facial artery survived without major complications. Facial profiles were well-restored, and salivary secretion was partially reserved. During the postoperative follow-up, no tumor recurrence was observed in any of the cases, and the volume of the SMGFs did not show obvious atrophy. CONCLUSIONS The modified SMGF is a viable solution for volume restoration and functional reconstruction after total parotidectomy. CLINICAL RELEVANCE This modified technique is simple and feasible for the functional reconstruction of soft tissue defects after total parotidectomy compared to other flaps and is worthy of clinical promotion.
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Affiliation(s)
- Hao Lu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Wanlin Xu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Wenya Zhu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Yifan Wu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Wenjun Yang
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China
| | - Shengwen Liu
- Department of Oral and Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; College of Stomatology, Shanghai Jiao Tong University, Shanghai, PR China; National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai, PR China; Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China; Shanghai Center of Head and Neck Oncology Clinical and Translational Science, Shanghai, PR China.
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Dilek ÖF, Sevim KZ, Dilek ON. Acellular dermal matrices in reconstructive surgery; history, current implications and future perspectives for surgeons. World J Clin Cases 2024; 12:6791-6807. [PMID: 39687641 PMCID: PMC11525903 DOI: 10.12998/wjcc.v12.i35.6791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 10/03/2024] [Accepted: 10/15/2024] [Indexed: 10/24/2024] Open
Abstract
Large-scale defects of body in the reconstructive surgical practice, and the helplessness of their repair with autologous tissues, have been an important factor in the development of artificial biological products for the temporary, definitive, or staged repair of these defects. A major advance in the field of plastic and other reconstructive surgery in this regard has been the introduction and successful use of acellular dermal matrices (ADMs). In recent years, not only the type of tissue from which ADMs are produced, product range, diversity and areas of use have increased, but their use in reconstructive fields, especially in post oncologic breast surgery, has become highly regarded and this has favored ADMs to be a potential cornerstone in specific and well-defined surgical fields in future. It is essential that reconstructive surgeons become familiar with some of the ADM's as well as the advantages and limitations to their use. This review not only provides basic science and clinical evidence of the current use of ADMs in wide range of surgical fields but also targets to keep them as an important backdrop in the armamentarium of reconstructive surgeons. Brief considerations of possible future directions for ADMs are also conducted in the end.
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Affiliation(s)
- Ömer F Dilek
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul 34396, Türkiye
| | - Kamuran Z Sevim
- Department of Plastic and Reconstructive Surgery, University of Health Sciences, Şişli Hamidiye Etfal Training and Research Hospital, İstanbul 34396, Türkiye
| | - Osman N Dilek
- Department of Surgery, İzmir Katip Celebi University, School of Medicine, İzmir 35150, Türkiye
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Consorti G, Monarchi G, Paglianiti M, Togni L, Mascitti M, Balercia P, Santarelli A. Reconstruction of oral mucosal defects with regenerative dermal matrix after T1-T2 squamocellular carcinoma resection. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101911. [PMID: 38719193 DOI: 10.1016/j.jormas.2024.101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 04/05/2024] [Accepted: 05/06/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Resection of tumors of oral cavity usually causes short- or long-term sequelae such as chewing, speech and swallowing impairment. To preserve this function it is necessary to maintain the lining of the oral cavity, the mobility and sensitivity of the tongue. Reconstructive options for oral mucosal defects resulting from tumor resection included primary closure, mucosal and skin grafts, pedicle and microvascular free flaps, and dermal matrix. STUDY DESIGN Retrospective study on patients undergoing reconstruction of intraoral defects, after removal of T1, T2 malignant tumors, by placement of bilayer dermal matrix. METHODS From 2021 to 2022, 47 patients with oral mucosa defects after removal of squamous cell carcinoma were treated. All patients were affected by a T1-T2 squamous cell carcinoma. For each patient, data were collected regarding the site of the disease, the initial staging, the size of the surgical defect, the complications and the outcome months after the operation. RESULTS In all treated cases the surgical defect involved the mucosa of the cheek, the oral floor or the tongue with an average size of 5.45cm2. Patients who underwent this type of reconstruction benefited from excellent healing of intraoral wounds and good restoration of oral function 6 months after surgery. Out of the total number of patients, membrane attachment failure was reported in only two cases. CONCLUSION As emerges from the data reported in our study, the dermal matrix represents a valid alternative in oncological reconstructive surgery for small/medium-sized intraoral mucosal defects because it allows re-epithelialization of the wound.
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Affiliation(s)
- Giuseppe Consorti
- Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, Ancona, Italy; Division of Maxillofacial Surgery, Department of Neurological Sciences, Marche University Hospitals- Umberto I, Via Conca 71, Ancona 60126 Italy.
| | - Gabriele Monarchi
- Department of medicine, Section of maxillo-facial surgery, University of Siena, Viale Bracci, Siena 53100, Italy
| | - Mariagrazia Paglianiti
- Department of medicine, Section of maxillo-facial surgery, University of Siena, Viale Bracci, Siena 53100, Italy
| | - Lucrezia Togni
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Marco Mascitti
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Paolo Balercia
- Division of Maxillofacial Surgery, Department of Neurological Sciences, Marche University Hospitals- Umberto I, Via Conca 71, Ancona 60126 Italy
| | - Andrea Santarelli
- Department of Clinical Specialistic and Dental Sciences, Marche Polytechnic University, Ancona, Italy
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Deng Y, Wang X, Qiao Z, Zhao H, Li C, Tian Y, Zeng W, Yan Q, Yang K, Sun Y, Xiong X. A Retrospective Study on the Reconstruction of Nasal Septal Mucosal Defects after Asian Rhinoplasty. Aesthetic Plast Surg 2024; 48:1321-1330. [PMID: 37749417 DOI: 10.1007/s00266-023-03655-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/06/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Nasal septal mucosal defects following rhinoplasty in Asian patients are uncommon complications. However, the reconstruction of such defects presents a challenging task in plastic surgery. The aim of this study was to present comprehensive surgical strategies for the reconstruction of nasal septal mucosal defect after rhinoplasty. METHODS Thirteen cases presenting with nasal septal mucosal defects between January 2016 and October 2021 were retrospectively reviewed. The size, location, and severity of the defect as well as the extent of cartilage exposure were taken into consideration during evaluation, and surgical approaches were employed for repair accordingly. Patient satisfaction was evaluated using a questionnaire with visual analog scale (VAS) and nasal obstruction symptom evaluation scale (NOSE). RESULTS The average postoperative follow-up period in this study group was 10.15 months. Reconstruction of nasal septal mucosal defects resulted in successful treatment for all patients. There was no evidence of flap failure or nasal valve stenosis. All patients were satisfied with the reconstruction outcome. CONCLUSIONS The successful application of surgical techniques for nasal septal mucosal defects after rhinoplasty requires comprehensive consideration. The utilization of the retrograde-flow superior labial artery mucosal flap appears to be a secure, efficient, and effective technique for nasal septal mucosal defect reconstruction in rhinoplasty, particularly in cases with cartilage exposure. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Yiwen Deng
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiancheng Wang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.
| | - Zhihua Qiao
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Hongli Zhao
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Chunjie Li
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yi Tian
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Weiliang Zeng
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Qiaoding Yan
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Kai Yang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Yang Sun
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
| | - Xiang Xiong
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China
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Wang A, Kwon D, Kim E, Oleru O, Seyidova N, Taub PJ. Statistical fragility of outcomes in acellular dermal matrix literature: A systematic review of randomized controlled trials. J Plast Reconstr Aesthet Surg 2024; 91:284-292. [PMID: 38432086 PMCID: PMC10984759 DOI: 10.1016/j.bjps.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/04/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Acellular dermal matrix (ADM) is commonly used in plastic and reconstructive surgery. With the abundance of randomized controlled trials (RCTs) reporting P-values for ADM outcomes, this study used the fragility index (FI), reverse fragility index (rFI), and fragility quotient (FQ) to evaluate the statistical stability of the outcomes in ADM RCTs. METHODS PubMed, Embase, SCOPUS, Medline, and Cochrane databases were reviewed for ADM RCTs (2003-present) reporting a dichotomous, categorical outcome. FI and rFI (event reversals influencing outcome significance) and FQ (standardized fragility) were calculated and reported as median. Subgroup analysis was performed based on intervention types. RESULTS Among the 127 studies screened, 56 RCTs with 579 outcomes were included. The median FI stood at 4 (3-5) and FQ was 0.04 (0.03-0.07). Only 101 outcomes were statistically significant with a median FI of 3 (1-6) and FQ of 0.04 (0.02-0.08). The nonsignificant outcomes had a median FI of 4 (3-5) and FQ of 0.04 (0.03-0.07). Notably, 26% of the outcomes had several patients lost to follow up equal to or surpassing the FI. Based on the intervention type, the median FIs showed minor fluctuations but remained low. CONCLUSIONS Outcomes from ADM-related RCTs were statistically fragile. Slight outcome reversals or maintenance of patient follow-up can alter the significance of results. Therefore, future researchers are recommended to jointly report FI, FQ, and P-values to offer a comprehensive view of the robustness in ADM literature.
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Affiliation(s)
- Anya Wang
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, New York, NY 10029, USA
| | - Daniel Kwon
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, New York, NY 10029, USA
| | - Esther Kim
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, New York, NY 10029, USA
| | - Olachi Oleru
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, New York, NY 10029, USA
| | - Nargiz Seyidova
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, New York, NY 10029, USA
| | - Peter J Taub
- Icahn School of Medicine at Mount Sinai, Division of Plastic and Reconstructive Surgery, New York, NY 10029, USA.
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Hirpara MM, Clark RC, Hogan E, Dean R, Reid CM. Rise of Acellular Dermal Matrix: Cost Consciousness, Industry Payment, and Publication Productivity. J Am Coll Surg 2023; 236:1189-1197. [PMID: 36757115 DOI: 10.1097/xcs.0000000000000648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Despite high cost and lack of FDA approval for breast surgery, acellular dermal matrix (ADM) has become commonplace in reconstructive surgery and has been the focus of more than 500 plastic surgery publications since its wide adoption. We hypothesized that ADM-related academic output would correlate with public interest and industry funding. STUDY DESIGN All PubMed-indexed studies focusing on ADM in 11 plastic surgery journals were included (n = 535). Data on industry funding to the 17 most productive authors were extracted from the Open Payments Database. Google Trends in "breast surgery cost" and related terms were queried. Relationships among publication quantity, author industry funding, and public interest were analyzed by Pearson's correlation and linear regression. RESULTS The most published authors produced 8 qualifying publications on average (range 5 to 17), with 80% focused on breast surgery. These individuals grossed a total of $19 million industry dollars overall with $17 million (89%) in nonconsulting compensation from ADM-producing companies (NC-ADM). Individual total compensation and NC-ADM compensation, by quartile, were $194,000/$320,000/$1.25 million and $17,000/$210,000/$1.1 million, respectively. These variables showed strong correlation with individual publication rate with a linear regression coefficient of $110K in NC-ADM per publication (p < 0.01). Authors disclosed funding in a mean ± SD of 65 ± 26% of their work with strong correlation between disclosure and NC-ADM (p < 0.01). Google "breast surgery cost" search volume has grown rapidly in significant correlation with ADM publications (p = 0.02). CONCLUSIONS This study demonstrates significant correlation between ADM-related publication, industry funding, funding disclosure, and public interest. Education in the potential for such relationships and the importance of objectivity in plastic surgery warrants discussion.
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Affiliation(s)
- Milan M Hirpara
- From the School of Medicine, California University of Science and Medicine, Colton, CA (Hirpara)
| | - Robert Craig Clark
- the Department of Plastic Surgery, School of Medicine, University of California San Diego, La Jolla, CA (Clark, Dean, Reid)
| | - Elise Hogan
- the College of Medicine, University of Cincinnati, Cincinnati, OH (Hogan)
| | - Riley Dean
- the Department of Plastic Surgery, School of Medicine, University of California San Diego, La Jolla, CA (Clark, Dean, Reid)
| | - Chris M Reid
- the Department of Plastic Surgery, School of Medicine, University of California San Diego, La Jolla, CA (Clark, Dean, Reid)
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Ceran F, Pilanci O, Ozel A, Ilbay G, Karabacak R, Kanter M, Ilbay K, Kuvat SV. Use of acellular dermal matrix in peripheral nerve reconstruction: an experimental study on rat sciatic nerve defect. J Plast Surg Hand Surg 2023; 57:445-452. [PMID: 36476277 DOI: 10.1080/2000656x.2022.2152824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In patients with nerve tissue defects, the use of autologous nerve grafts is the standard method of treatment. Alternatives to autologous, nerve grafts have attracted the attention of reconstructive surgeons. In this study, the results of nerve repairs using acellular dermal matrix (ADM) in an experimental rat sciatic nerve defect model are presented. METHODS Thirty-six Sprague-Dawley rats were randomized into 5 groups: Group 1: control group, Group 2: negative control group (n = 6), Group 3: autologous nerve graft group (n = 10), Group 4: donor site entubulated with ADM group (n = 10); and Group 5: nerve graft entubulated with ADM group (n = 10). The animals in each group were evaluated for electrophysiologic functions, gastrocnemius muscle weight and histomorphology on the 3rd and 6th month. RESULTS The compound muscle action potential was observed to be distinctly lower in Groups 3, 4 and 5 in comparison to the control group. In Group 4, the gastrocnemius ratio (GCR) values on the 6th month were statistically significantly lower than the GCR values in Group 3 and Group 5, The histological scores and myelinated axonal counts in Group 5 were statistically significantly higher than the values in Group 3 and Group 4. CONCLUSION The results of this study showed that wrapping ADM around nerve grafts resulted in better outcomes with respect to nerve healing.
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Affiliation(s)
- Fatih Ceran
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medicalpark Hospital, Batman, Turkey
| | - Ozgur Pilanci
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Asuman Ozel
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
| | - Gul Ilbay
- Faculty of Medicine, Department of Physiology, Kocaeli University, Kocaeli, Turkey
| | - Rukiye Karabacak
- Faculty of Medicine, Department of Histology, Medeniyet University, Istanbul, Turkey
| | - Mehmet Kanter
- Faculty of Medicine, Department of Histology, Medeniyet University, Istanbul, Turkey
| | - Konuralp Ilbay
- Faculty of Medicine, Department of Neurosurgery, Kocaeli University, Kocaeli, Turkey
| | - Samet Vasfi Kuvat
- Department of Plastic, Reconstructive and Aesthetic Surgery, Bagcilar Training and Research Hospital, Istanbul, Turkey
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Kwon MY, Lee SU, Kim WB, Lee Y, Pang CH, Kim T, Oh CW, Bang JS. Implantation of Acellular Dermal Matrix to Prevent Frontotemporal Depression Following Minipterional Craniotomy for the Surgical Clipping of Unruptured Intracranial Aneurysms. World Neurosurg 2022; 166:e11-e22. [PMID: 35569746 DOI: 10.1016/j.wneu.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/05/2022] [Accepted: 05/05/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of the study was to assess the esthetic efficacy of acellular dermal matrix (ADM) implantation to prevent frontotemporal depression (FTD) following minipterional craniotomy (MPT) to clip unruptured intracranial aneurysms. METHODS We retrospectively compared the incidence of FTD in 100 patients treated without ADM from March to July 2019 and 100 patients treated with ADM from August to December 2019. ADM was implanted in the interfascial layer to cover the temporalis muscle. The specific location and degree of FTD were analyzed by measuring the thickness and area of multiple points (P1-P12) and regions (S1-S3) through brain computed tomography preoperatively and 1 year postoperatively. RESULTS In the non-ADM group, the thickness at P1, P2, P5, P6, and P9 was reduced and the area of S1 and S2 was smaller after surgery than before surgery (P < 0.05), similar to the incision and suture site of the temporalis muscle. However, in the ADM group, the preoperative and postoperative measurements were not different. FTD recognition was significantly lower in the ADM group (6.0%) than that in the non-ADM group (17.0%) (P = 0.015) and occurred in the retroorbital region through P1, P2, P5, and P6, with the area under the receiver operating characteristic curves of 0.840, 0.766, 0.811, and 0.751, respectively. ADM implantation was the only significant predictive factor for FTD recognition in multivariate logistic regression analysis (odds ratio = 0.30; 95% confidence interval: 0.11-0.79; P = 0.015). CONCLUSIONS Even MPT cannot completely prevent FTD in the retroorbital region. ADM implantation in MPT can help to improve esthetic satisfaction.
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Affiliation(s)
- Min-Yong Kwon
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Si Un Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Woong-Beom Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yongjae Lee
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chang Hwan Pang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Tackeun Kim
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Chang Wan Oh
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae Seung Bang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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10
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Gonzalez GA, Castagno C, Carter J, Chellappan B, Taupin P. Negative pressure wound therapy on complex extremity wounds requiring coverage with a meshed bilayer wound matrix: a retrospective analysis. J Wound Care 2022; 31:S8-S15. [PMID: 36113853 DOI: 10.12968/jowc.2022.31.sup9.s8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The treatment of complex extremity wounds is technically challenging. In this 5-year retrospective review, we compared the use of Integra Meshed Bilayer Wound Matrix (IMBWM; Integra LifeSciences, US) followed by a split-thickness skin graft (STSG) combined with negative pressure wound therapy (NPWT) versus IMBWM followed by STSG alone for the management of these wounds. METHOD Data from patients undergoing management using IMBWM for a complex extremity wound coverage were collected. RESULTS Among the 109 patients studied, the wounds of 62 patients were managed using IMBWM and NPWT, and 47 were managed using IMBWM alone. The most common aetiology of these injuries was trauma. Wound size and location were similar for each group, ranging in size from 2-30cm2 and being primarily on the forearm, followed by the leg and arm. There was a significantly greater take of the IMBWM+STSG with NPWT (96.8%) compared to without NPWT (85.1%, p=0.03). There were significantly fewer reapplications of the dermal matrix required in the NPWT group (3.2%) versus the non-NPWT group (14.9%, p=0.03). There were significantly fewer postoperative complications, prior to STSG, in the NPWT group (3.2%) versus the non-NPWT group (14.9%, p=0.03). CONCLUSION The combination of IMBWM with NPWT leads to a higher success rate, and can reduce the number of dermal matrix reapplications and postoperative complications, in the setting of complex extremity wounds. The use of IMBWM in combination with NPWT has the potential to improve both surgical procedures and patient outcomes in this setting.
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Affiliation(s)
| | | | - Jordan Carter
- Texas Tech University Health Sciences Center, El Paso, TX, US
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11
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Huang Q, Fang Y, Wang Y, Liao H. Clinical observation on healing of tarsal plate defect after reconstruction with xenogeneic acellular dermal matrix. BMC Ophthalmol 2022; 22:326. [PMID: 35906559 PMCID: PMC9335983 DOI: 10.1186/s12886-022-02540-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/19/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the safety, function, and cosmetic outcome of eyelid reconstruction using a xenogeneic acellular dermal matrix as a tarsal plate replacement in the repair of 50 to 100% eyelid defects following excision of large malignant tumours. Methods A retrospective, non-comparative, interventional study of 21 eyes was performed over 26 months. Fourteen patients were female and seven were male. In all cases, a xenogeneic acellular dermal matrix was used for total or subtotal replacement of the tarsal plate. The central vertical height of the palpebral fissure was measured immediately after eyelid margin incision and at 1 and 6 months postoperatively. Results In patients who underwent surgery, the mean palpebral fissure height (PFH) was not significantly different between immediately and 1 month after incision (8.10 ± 0.562 mm vs 8.17 ± 0.577 mm, respectively; P > 0.05). After 6 months, PFH was 8.26 ± 0.605 mm, which was significantly different from that immediately after incision (P < 0.05). After 6 months of follow-up, all patients had a good aesthetic appearance after eyelid reconstruction, with no obvious graft dissolution or rejection, normal eyelid activity, and normal opening, closing, and lifting function. None of the 21 patients experienced tumour recurrence during postoperative follow-up. Conclusion The xenogeneic acellular dermal matrix was a successful tarsal plate replacement. This material is readily available, and a second surgical site is avoided. The xenogeneic acellular dermal matrix is considered a promising alternative material for tarsal replacement in future generations.
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Affiliation(s)
- Qin Huang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Research Institute of Ophthalmology and Visual Science, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China.
| | - Yangbin Fang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Research Institute of Ophthalmology and Visual Science, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Yaohua Wang
- Affiliated Eye Hospital of Nanchang University, Jiangxi Research Institute of Ophthalmology and Visual Science, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China
| | - Hongfei Liao
- Affiliated Eye Hospital of Nanchang University, Jiangxi Research Institute of Ophthalmology and Visual Science, Jiangxi Provincial Key Laboratory for Ophthalmology, Nanchang, Jiangxi, China.
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12
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Acellular Dermal Matrix Favorably Modulates the Healing Response after Surgery. Plast Reconstr Surg 2022; 150:290e-299e. [PMID: 35653544 DOI: 10.1097/prs.0000000000009338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
SUMMARY When first described for breast reconstruction, the presence of acellular dermal matrices (ADM) was associated with increased seroma formation and infection. However, clinical safety data has gradually improved with surgeon experience to an acceptable outcomes profile of ADM-assisted reconstruction when compared to submuscular implant coverage. In fact, ADM use potentially decreases capsular contracture rates and facilitates expansion for staged pre-pectoral breast reconstruction. Due to new regulatory requirements, the collection of unbiased, well-powered pre-market approval data summarizing long-term clinical outcomes will be essential over the coming years to understand the clinical performance of ADM usage in breast reconstruction.Currently, we can highlight the physiologic benefits of ADM use in breast reconstruction by evaluating the components of surgical wound healing that are favorably augmented by the implanted collagen substrate. ADM takes advantage of the wound healing cascade to incorporate into the patient's tissues - a process that requires a coordinated inflammatory infiltrate and angiogenesis. The presence of ADM augments and modulates the wound healing process to its advantage by simultaneously increasing the invasion of appropriate cellular constituents to facilitate expeditious healing and accelerate angiogenesis. Herein, we summarize the wound healing literature to demonstrate the mechanisms ADM use to biointegrate and the literature in which cellular constituents and soluble growth factors are upregulated in the presence of ADM. Lastly, we use our experimental observations of ADM incorporation to corroborate the literature.
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13
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Modular Bioreactor Design for Directed Tendon/Ligament Tissue Engineering. Bioengineering (Basel) 2022; 9:bioengineering9030127. [PMID: 35324816 PMCID: PMC8945228 DOI: 10.3390/bioengineering9030127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/30/2022] Open
Abstract
Functional tissue-engineered tendons and ligaments remain to be prepared in a reproducible and scalable manner. This study evaluates an acellular 3D extracellular matrix (ECM) scaffold for tendon/ligament tissue engineering and their ability to support strain-induced gene regulation associated with the tenogenesis of cultured mesenchymal stromal cells. Preliminary data demonstrate unique gene regulation patterns compared to other scaffold forms, in particular in Wnt signaling. However, the need for a robust bioreactor system that minimizes process variation was also evident. A design control process was used to design and verify the functionality of a novel bioreactor. The system accommodates 3D scaffolds with clinically-relevant sizes, is capable of long-term culture with customizable mechanical strain regimens, incorporates in-line load measurement for continuous monitoring and feedback control, and allows a variety of scaffold configurations through a unique modular grip system. All critical functional specifications were met, including verification of physiological strain levels from 1–10%, frequency levels from 0.2–0.5 Hz, and accurate load measurement up to 50 N, which can be expanded on the basis of load cell capability. The design process serves as a model for establishing statistical functionality and reliability of investigative systems. This work sets the stage for detailed analyses of ECM scaffolds to identify critical differentiation signaling responses and essential matrix composition and cell–matrix interactions.
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14
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Sagalow ES, Christopher V, Banoub RG, Gill KS, Xu V, Jain N, Malkani K, Elmer N, Zhan T, Stanek JJ, Hwang M, Krein HD, Heffelfinger RN. Rate of Fat Graft Volume Loss After Parotidectomy. J Craniofac Surg 2022; 33:2082-2086. [DOI: 10.1097/scs.0000000000008615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Kravtsova AV, Pyatikop VO, Sergiyenko YG. DUROPLASTY: REVIEW OF MATERIALS AND TECHNIQUES. EASTERN UKRAINIAN MEDICAL JOURNAL 2022; 10:1-16. [DOI: 10.21272/eumj.2022;10(1):1-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2025]
Abstract
Introduction. Degenerative disc disease is one of the most common diseases of the musculoskeletal system, characterized by dystrophic changes in the intervertebral disc and vertebral bodies adjacent to it. The main symptoms of this disease are pain and sensory and motor disorders, which, according to various authors, occur in 50–80% of adults.
The main objective of the study was to find and implement the optimal set of treatment measures for degenerative disc disease depending on the age of a patient.
Materials and Methods. The medical records of inpatients who were treated in the Neurosurgical Department of the Sumy Regional Clinical Hospital in 2019–2020 were analyzed. The course of treatment of 93 patients (61 men and 32 women) was studied. The patients were divided into groups according to their age: young age (under 25) – 13 men and 8 women; middle age (under 60) – 24 men and 19 women; and elderly age (over 60 years) – 18 men and 11 women.
The combined use of pathogenetically justified physiotherapeutic measures in the treatment complex is gaining more and more interest. Their distinctive features are physiologic nature, absence of allergic manifestations, the ability to influence most of the pathogenesis of the disease, and the organic combination with other therapeutic factors. Unfortunately, there is an increase in the incidence of temporary incapacitation and progressive course, which often leads to disability and significant financial costs associated with expensive modern methods of diagnosis, treatment, and further provision of employment to patients.
The results of our study show that complex treatment including pathogenetic drug therapy, complex paravertebral block, therapeutic physical exercise, and physiotherapy treatment methods provides adequate recovery of spinal function regardless of dystrophic and degenerative changes severity and patient's age.
Treatment of degenerative disc disease should be comprehensive and directed at the various symptoms and links of the pathological process.
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16
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Patel S, Ziai K, Lighthall JG, Walen SG. Biologics and acellular dermal matrices in head and neck reconstruction: A comprehensive review. Am J Otolaryngol 2022; 43:103233. [PMID: 34537508 DOI: 10.1016/j.amjoto.2021.103233] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/09/2021] [Indexed: 11/30/2022]
Abstract
Acellular dermal matrices (ADMs) have been studied extensively in the literature and have gained popularity for various reconstructive and aesthetic purposes. ADMs are composed of a basement membrane and acellular dermal layer of collagen and provide a platform for mucosal epithelization and neovascularization. Combining dermal collagen and essential growth factors allows ADMs to support adequate wound healing and bolster soft-tissue repairs. These dermal matrices can be derived from human cadaveric donor skin (allogenic) or mammalian donor sources (xenogeneic). These dermal substitutes provide the benefit of reducing or eliminating the need for autologous tissue grafts and subsequently minimize donor site morbidity. Many ADMs are currently available in the market, each with variations in processing, manufacturing, storage, preparation, and use. The literature validating ADMs in the head and neck for both cosmetic and reconstructive purposes is evolving rapidly. This review aims to provide an up-to-date and comprehensive overview of the principles of acellular dermal matrices (ADMs), the different types of ADMs, and evaluate common indications, techniques, and outcomes pertaining to select anatomic sites in the head and neck reconstruction.
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Affiliation(s)
- Shivam Patel
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Kasra Ziai
- Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Jessyka G Lighthall
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA
| | - Scott G Walen
- Division of Facial Plastic & Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, The Pennsylvania State University, College of Medicine, Hershey, PA, USA.
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17
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Cameron N, Balsiger R, Prueter J, Kadakia S. Transfacial transmandibular approach to the masticator space: Excision of odontogenic myxoma arising from the mandibular condyle. Am J Otolaryngol 2021; 42:102944. [PMID: 33592553 DOI: 10.1016/j.amjoto.2021.102944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 11/16/2022]
Abstract
Odontogenic myxomas are an uncommon benign odontogenic tumor that can present with a wide variety of symptomatology depending on location and potentially be locally destructive. The present case describes a 66-year-old female who presented with left lower facial paresthesia, left aural fullness and hearing loss. She was found to have an odontogenic myxoma that involved the condylar head and extended into the masticator space. In this report we detail our surgical approach utilizing a preauricular transfacial transmandibular approach to the masticator space. In addition, we will discuss various approaches to the masticator space and infratemporal fossa along with considerations on how to manage facial nerve paralysis, facial contour deformities, and post-operative rehabilitation for permanent unilateral condylar head disarticulation.
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Affiliation(s)
- Nicholas Cameron
- Department of Otolaryngology-Head and Neck Surgery, Kettering Health Network, Dayton, OH, United States of America.
| | - Robert Balsiger
- Ohio University Heritage College of Osteopathic Medicine, Dublin, OH, United States of America.
| | - James Prueter
- Department of Otolaryngology-Head and Neck Surgery, Southwest Ohio ENT, Dayton, OH, United States of America
| | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Boonshoft School of Medicine at Wright State University, Premier Health Comprehensive Head and Neck Oncology and Reconstruction Program, 30 E Apple St, Suite 2200, Dayton, OH 45409, United States of America.
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18
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Zheng X, Chen Y, Dan N, Dan W, Li Z. Highly stable collagen scaffolds crosslinked with an epoxidized natural polysaccharide for wound healing. Int J Biol Macromol 2021; 182:1994-2002. [PMID: 34062157 DOI: 10.1016/j.ijbiomac.2021.05.189] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/10/2021] [Accepted: 05/28/2021] [Indexed: 01/13/2023]
Abstract
As a biocompatible and bioactive natural tissue engineering collagen scaffold, porcine acellular dermal matrix (pADM) has limitations for the application in tissue regeneration due to its low strength and rapid biodegradation. Herein, to get a good wound dressing, the epoxy group was added to N-(2-hydroxypropyl)-3-trimethylammonium chitosan chloride (HTCC) to synthesize the epoxidized N-(2-hydroxypropyl)-3-trimethylammonium chitosan chloride (EHTCC), and the porcine acellular dermal matrix was modified with EHTCC at different dosage of 0, 4, 8, 12, 16 and 20%. The properties of the EHTCC-pADM were evaluated. The results indicated that the thermal stability and mechanical properties of EHTCC-pADM were remarkably improved, and the natural conformation of the matrix was maintained, which was beneficial to natural and excellent biological properties of the pADM. According to the test results of water contact angle, the hydrophilicity of the material was improved, which is conducive to cell adhesion, proliferation and growth. Cytotoxicity experiments showed that the introduction of EHTCC would not adversely affect the biocompatibility of the materials. In vivo experiments showed that EHTCC-pADM could promote wound healing. In conclusion, EHTCC-pADM is a potential collagen-based dressing for wound healing.
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Affiliation(s)
- Xin Zheng
- National Engineering Research Center for Clean Technology of Leather Manufacture, Sichuan University, Chengdu 610065, China; The Research Center of Biomedicine Engineering of Sichuan University, Chengdu 610065, China
| | - Yining Chen
- National Engineering Research Center for Clean Technology of Leather Manufacture, Sichuan University, Chengdu 610065, China; The Research Center of Biomedicine Engineering of Sichuan University, Chengdu 610065, China
| | - Nianhua Dan
- National Engineering Research Center for Clean Technology of Leather Manufacture, Sichuan University, Chengdu 610065, China; The Research Center of Biomedicine Engineering of Sichuan University, Chengdu 610065, China.
| | - Weihua Dan
- National Engineering Research Center for Clean Technology of Leather Manufacture, Sichuan University, Chengdu 610065, China; The Research Center of Biomedicine Engineering of Sichuan University, Chengdu 610065, China.
| | - Zhengjun Li
- National Engineering Research Center for Clean Technology of Leather Manufacture, Sichuan University, Chengdu 610065, China; The Research Center of Biomedicine Engineering of Sichuan University, Chengdu 610065, China
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19
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Tognetti L, Pianigiani E, Ierardi F, Lorenzini G, Casella D, Liso FG, De Pascalis A, Cinotti E, Rubegni P. The use of human acellular dermal matrices in advanced wound healing and surgical procedures: State of the art. Dermatol Ther 2021; 34:e14987. [PMID: 33993627 DOI: 10.1111/dth.14987] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 05/12/2021] [Indexed: 12/26/2022]
Abstract
Wound closure after post-traumatic injuries and/or localized at peculiar body sites (head-and-neck, oral cavity, legs) are particularly challenging and can often be delayed due to local and systemic factors. In case of deep wounds and/or hard-to-heal wounds, grafting of dermal acellular matrices (ADM) is often needed. Though a great variety of synthetic and semisynthetic dermal and skin equivalents are available, viable human dermis, is still considered the most physiological alternative to replace the loss of autologous dermis, by acting as a physiological scaffold that add structural support to soft tissues. To date, human ADMs (hADMs) have been employed in the reconstruction of skin defects affecting almost all body sites, ranging from visceral sites to the skin and subcutaneous tissues. This review aims to investigate the use of hADM at different body sites and their peculiar advantages. A literature search was using the search terms "acellular dermal matrices", "dermal regeneration", "advances wound healing", "human acellular dermal matrices surgery". A total of 50 out of 150 papers was included. Based on the current body if evidence, hADMs appear to bring several advantages, such as: protection of deep structures (eg, tendons, bones, cartilage and nerves); stimulation of a functional new dermis (rather than a scar); reduction of wound closure time; control of pain and exudate. Finally, hADMs may represent the best treatment option for hard-to-heal wound not only in terms of efficacy and patient satisfaction bout also in terms of sanitary costs, especially across Europe, where hADMs cannot be commercialized as medical devices.
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Affiliation(s)
- Linda Tognetti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Elisa Pianigiani
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Francesca Ierardi
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Guido Lorenzini
- Department of Odontostomatologic and Ophthalmologic Sciences, University of Siena, Siena, Italy
| | - Donato Casella
- Department of Breast Cancer Surgery, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Flavio Giulio Liso
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Andrea De Pascalis
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy
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20
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Li Y, Zhang P, Zhang X, Bi X, Wu M, Zou J, Wang Z, Lu F, Dong Z, Gao J. Adipose matrix complex: a high-rigidity collagen-rich adipose-derived material for fat grafting. Aging (Albany NY) 2021; 13:14910-14923. [PMID: 34111029 PMCID: PMC8221321 DOI: 10.18632/aging.203120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/09/2021] [Indexed: 12/21/2022]
Abstract
Due to the low percentage of collagen, the rigid support capacity of fat grafts remains unsatisfactory for some clinical applications. In this study, we evaluated a strategy in which adipose matrix complex (AMC) was collected via a mechanical process and transplanted for supportive filling of the face. Our AMC samples were collected from adipose tissue by a filter device consisting of a sleeve, three internal sieves, and a filter bag (100 mesh). AMC derived from adipose tissue had fewer cells than Coleman fat, but much higher levels of collagen and stiffness. Retention rates 90 days after transplantation in nude mice were higher for AMC than for Coleman fat (75±7.5% vs. 42±13.5%; P < 0.05). In addition, AMC maintained a higher stiffness (~6 kPa vs. ~2 kPa; P < 0.01) and stably retained a higher level of collagen. Our findings demonstrate that mechanical collection of AMC from adipose tissue is a practical method for improving fat graft retention and rigid support. This strategy has the potential to improve the quality of lipoaspirates for patients requiring rigid supportive filling.
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Affiliation(s)
- Ye Li
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Pan Zhang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Xue Zhang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Xin Bi
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Mengfan Wu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Jialiang Zou
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Zijue Wang
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Feng Lu
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Ziqing Dong
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
| | - Jianhua Gao
- Department of Plastic and Cosmetic Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, P.R. China
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21
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Gourishetti SC, Chen JH, Isaiah A, Vakharia K. Predictors of Postoperative Complications After Paramedian Forehead Flaps. Facial Plast Surg Aesthet Med 2021; 23:469-475. [PMID: 33847523 DOI: 10.1089/fpsam.2020.0570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Importance: The predictors of postoperative complications after paramedian forehead flaps (PMFF) are unknown. Objective: To determine whether preoperative factors can predict post-PMFF complications. Design, Setting, Participants: A retrospective review of 1438 adults from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database who underwent PMFF between 2010 and 2018. Main Outcomes and Measures: Surgical complications, medical complications, and all-cause mortality. Results: Of the 1438 patients, 75 experienced postoperative complications (5.2%). Of these, 36 developed isolated surgical complications (2.5%), 29 developed isolated medical complications (2.0%), and 8 developed concurrent surgical and medical complications (0.5%). Of the three mortalities (0.2%), one patient developed concurrent surgical and medical complications. A dirty or infected wound classification was the strongest predictor of postoperative complications (odds ratio [OR] 13.5; confidence interval [95% CI] 3.4-49.5). In contrast, the likelihood of postoperative complications decreased significantly with outpatient procedures (OR 0.4; 95% CI 0.2-0.8). Conclusions and Relevance: A dirty or infected wound classification is the strongest predictor of postoperative complications after PMFF.
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Affiliation(s)
- Saikrishna C Gourishetti
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jonathan H Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Amal Isaiah
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kalpesh Vakharia
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
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22
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Mantelakis A, Kostantinos A, D'Souza A, Joshi A. Use of Novel Decellularized Cadaveric Dermis (DCELL) in Single-Stage Resection and Reconstruction of Nonmelanomatous Skin Cancer of the Head and Neck. Facial Plast Surg 2021; 37:599-605. [PMID: 33648014 DOI: 10.1055/s-0041-1725163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Reconstructive options in nonmelanomatous skin tumors of the head and neck region are limited in the frail, elderly patient group, where split skin thickness or full thickness grafts may not be a viable option. This study examines the use decellularized cadaveric dermis (DCELL), an acellular dermis product produced in the United Kingdom for the reconstruction of these skin defects. This was a single-center, prospective study of patients undergoing single stage wide local excision of nonmelanomatous skin cancer and reconstruction with decellularized dermis. Our inclusion criteria included any patient that required a curative excision but had risk factors where conventional local flap or free tissue transfer could have a potential adverse outcome. Thirty-seven wounds were treated with DCELL in 31 patients. Mean age was 81.6 years (range 61-94 years) and at the time of operation, 25 patients (80.7%) were ASA 3 or above. The scalp was the most common anatomical area operated on (n = 28, 75.7%). The overall proportion of wounds with complete closure was 89.2% (33 out of 37 wounds), with a failure rate of 10.8% (four complete graft failures). Device-related complications included one episode of crusting over the graft which resolved with topical antibiotics, and a hypertrophic scar over the wound edges. Cosmesis was satisfactory in all cases. DCELL demonstrated a very good take rate with equally satisfactory cosmetic outcomes in patients where standard reconstructive approaches may have adverse outcomes. Further research is needed to better define its role in the management of these skin cancers.
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Affiliation(s)
- Angelos Mantelakis
- Department of Otolaryngology, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Argiris Kostantinos
- Deparmnet of ENT and Facial Plastic and Reconstructive Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Alwyn D'Souza
- Department of ENT and Facial Plastic Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
| | - Anil Joshi
- Deparmnet of ENT and Facial Plastic and Reconstructive Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
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Zhou B, Yuan KF, Chen WL. Use of allograft dermal matrix for repairing large oral epithelial defects: Outcomes of patients with lingual and buccal leukoplakia. J Cosmet Dermatol 2021; 20:2753-2757. [PMID: 33538098 DOI: 10.1111/jocd.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The best treatment approach for wide oral leukoplakia (OL) remains to be determined. AIMS To evaluate the outcomes of using an allograft dermal matrix (ADM) for reconstructing large oral epithelial defects following resection of OLs. PATIENTS AND METHODS A total of 27 OLs in 26 patients were excised, and residual large lingual and buccal epithelial defects were reconstructed using an ADM, which ranged in size from 3.0 × 5.0 to 6.0 × 6.0 cm. The patients were classified into mild (n = 1), moderate (n = 13), and severe dysplasia (n = 12) groups; 57.7% of the patients were tobacco smokers, 46.2% were alcoholics, 47.2% were both smokers and alcoholics, and 11.5% were both smoking and betel quid chewers. Patients who underwent surgery were advised to quit smoking, drink alcohol in moderation, or quit betel quid chewing. RESULTS Two patients developed slight hematomas that resolved spontaneously within 2 weeks. A total of 76.9% of the smokers followed the advice to quit smoking, 83.3% of the alcoholics followed the advice to drink in moderation, and all three betel quid chewers followed the advice to quit chewing betel quid. The mean follow-up was 26.7 months. No MT occurred and recurrence was seen in two patients. CONCLUSIONS Large epithelial defect reconstruction using an ADM following resection of wide lingual and buccal OLs was safe and reliable for preventing MT of OL. The recurrence of OL may be related to patient habits such as tobacco smoking or/and drinking alcohol.
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Affiliation(s)
- Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kai-Fang Yuan
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Kim JH, Kim DH, Lim JY, Won HR, Shin YS, Kim CH, Ban MJ, Park JH, Byeon HK, Hong HJ, Choi EC, Koh WY. Effect of human acellular dermal matrix (Megaderm™) on infra-auricular depressed deformities, Frey's syndrome, and first bite syndrome following parotidectomy: a multi-center prospective study. Gland Surg 2021; 10:670-677. [PMID: 33708549 DOI: 10.21037/gs-20-703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Parotidectomy is the primary treatment for parotid gland tumors. However, complications may include a prominent facial scar or infra-auricular depressed deformity, Frey's syndrome, first bite syndrome, or other facial pain, numbness, and paralysis. Acellular dermal matrix (ADM) has been widely used to prevent these complications in parotid surgery, but there have been no prospective, multi-center trials documenting its efficacy. This study evaluates the effectiveness of ADM implantation in preventing infra-auricular depressed deformity, Frey's syndrome and first bite syndrome after parotidectomy. Methods We analyzed 51 cases of standard parotidectomy and 58 cases of parotidectomy with implantation of Megaderm™ ADM through prospective multicenter trial. Acute complications including infection, seroma, hematoma, skin necrosis, and acute parotid area pain were evaluated 1 week postoperatively. Clinician grading of Frey's syndrome and blinded clinician evaluation of infra-auricular depressed deformities were conducted at 3, 6, and 12 months. Patients evaluated subjective satisfaction with neck appearance, Frey's syndrome quality, and acute parotid area pain at 3, 6, and 12 months. Results There was a higher incidence of seroma in the Megaderm™ group than in the control group at week 1. The incidence and total clinician-evaluated Frey's syndrome scores were significantly lower in the Megaderm™ group than in the control group at 3, 6, and 12 months. Both the objective and subjective evaluations of the facial contour showed a better outcome in the Megaderm™ group compared to the control group at 3, 6, and 12 months. There were no significant differences between the groups in the patient-reported Frey's syndrome quality scores at 3, 6, and 12 months, but the Megaderm™ group reported significantly less acute pain than the control group. Conclusions ADM implantation can effectively reduce the occurrence of Frey's syndrome, infra-auricular depressed deformity, and first bite syndrome after parotidectomy. ADM may be especially advantageous in complex parotidectomy cases when significant complications are expected.
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Affiliation(s)
- Joo Hyun Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Da Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Yol Lim
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho-Ryun Won
- Department of Otorhinolaryngology-Head and Neck Surgery, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yoo Seob Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Ajou University College of Medicine, Kungki-do, Republic of Korea
| | - Chul-Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Ajou University College of Medicine, Kungki-do, Republic of Korea
| | - Myung Jin Ban
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Jae Hong Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyung Kwon Byeon
- Department of Otorhinolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Cheonan, Republic of Korea
| | - Hyun Jun Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Catholic Kwandong University College of Medicine, Incheon, Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woon Yoo Koh
- Department of Otorhinolaryngology-Head and Neck Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
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Samson DJ, Gachabayov M, Latifi R. Biologic Mesh in Surgery: A Comprehensive Review and Meta-Analysis of Selected Outcomes in 51 Studies and 6079 Patients. World J Surg 2021; 45:3524-3540. [PMID: 33416939 DOI: 10.1007/s00268-020-05887-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND In recent decades, biologic mesh (BM) has become an important adjunct to surgical practice. Recent evidence-based clinical applications of BM include but are not limited to: reconstruction of abdominal wall defects; breast reconstruction; face, head and neck surgery; periodontal surgery; other hernia repairs (diaphragmatic, hiatal/paraesophageal, inguinal and perineal); hand surgery; and shoulder arthroplasty. Prior systematic reviews of BM in complex abdominal wall hernia repair had several shortcomings that our comprehensive review seeks to address, including exclusion of laparoscopic repair, assessment of risk of bias, use of an acceptable meta-analytic method and review of risk factors identified in multivariable regression analyses. MATERIALS AND METHODS We sought articles of BM for open ventral hernia repair reporting on early complications, late complications or recurrences and included minimum of 50. We used the quality in prognostic studies risk of bias assessment tool. Random effects meta-analysis was applied. RESULTS This comprehensive review selected 62 articles from 51 studies that included 6,079 patients. Meta-analytic pooling found that early complications are present in about 50%, surgical site occurrences (SSOs) in 37%, surgical site infections (SSIs) in 18%, reoperation in 7%, readmission in 20% and mortality in 3%. Meta-analytic estimates of late outcomes included overall complications (42%), SSOs (40%) and SSIs (22%). Specific SSOs included seroma (14%), hematoma (4%), abscess (10%), necrosis (5%), dehiscence (8%) and fistula formation (5%). Reoperation occurred in about 17%, mesh explantation in 9% and recurrence in 36%. CONCLUSION Estimates of nearly all outcomes from individual studies were highly heterogeneous and sensitivity analyses and meta-regressions generally failed to explain this heterogeneity. Recurrence is the only outcome for which there are consistent findings for risk factors. Bridge placement of BM is associated with higher risk of recurrence. Prior hernia repair, history of reintervention and history of mesh removal were also risk factors for increased recurrence.
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Affiliation(s)
- David J Samson
- Department of Surgery, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Suite D-353, Valhalla, NY, 10595, USA
| | - Mahir Gachabayov
- Department of Surgery, New York Medical College, School of Medicine, Valhalla, NY, 10595, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center, 100 Woods Road, Taylor Pavilion, Suite D-353, Valhalla, NY, 10595, USA. .,Department of Surgery, New York Medical College, School of Medicine, Valhalla, NY, 10595, USA.
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Chang SH, Huang ZS, Chen WL, Zhou B, Zhong JL. Vermilionectomy followed by reconstruction of the vermilion mucosa using allograft dermal matrix in patients with actinic cheilitis of the lower lip. J Cosmet Dermatol 2020; 20:263-266. [PMID: 32396694 DOI: 10.1111/jocd.13473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 03/25/2020] [Accepted: 05/02/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND When treating actinic cheilitis (AC), it is essential to minimize the risk of malignant transformation (MT) and maintain lip functionality and cosmesis. AIMS We evaluated the outcomes of vermilionectomy followed by reconstruction of the vermilion mucosa using allograft dermal matrix (ADM) in patients with AC of the lower lip. MATERIALS AND METHODS We evaluated eight patients with lower lip AC who underwent vermilion mucosa reconstruction using ADM after vermilionectomy. We enrolled five males and three females ranging in age from 55 to 70 years (mean, 62.1 years). The ADM ranged in area from 1.3 × 5.0 to 1.7 × 5.8 cm (median, 1.6 × 5.5 cm). All patients were followed up for at least 3 months postoperatively by a panel of three surgeons who assessed the esthetic results, and orbicularis oris and speech functions. RESULTS All patients underwent successful reconstruction of the vermilion mucosa using ADM after vermilionectomy, without complications. The postoperative esthetic results, and the orbicularis oris and speech functions, were satisfactory to excellent in all patients. Patients were followed up for 18-38 months (median, 26.1 months). No MT or recurrence was noted. CONCLUSIONS Vermilionectomy followed by reconstruction of the vermilion mucosa with ADM is safe and feasible for AC patients.
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Affiliation(s)
- Shao-Hai Chang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhuo-Shan Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bin Zhou
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jiang-Long Zhong
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Liang KY, Breen MS, Tracy JC, Vaezi AE. Submandibular gland flap for reconstruction after parotidectomy. Laryngoscope 2020; 130:E155-E162. [DOI: 10.1002/lary.28037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/15/2019] [Accepted: 04/11/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Kevin Y. Liang
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Matthew S. Breen
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Jeremiah C. Tracy
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
| | - Alec E. Vaezi
- Department of Otolaryngology–Head and Neck SurgeryUniversity of Massachusetts Medical School Worcester Massachusetts U.S.A
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Tork S, Jefferson RC, Janis JE. Acellular Dermal Matrices: Applications in Plastic Surgery. Semin Plast Surg 2019; 33:173-184. [PMID: 31384233 DOI: 10.1055/s-0039-1693019] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Modern advances in tissue engineering have transformed the plastic surgeon's management strategies across a wide variety of applications. Comprehension of the fundamentals of biologic constructs is critical to navigating the available armamentarium. It is essential that plastic surgeons become familiar with some of the existing methods for utilizing biologics as well as the advantages and limitations to their use. In this article, the authors describe the basic science of biologics with a focus on acellular dermal matrices (ADMs), and review the recent evidence behind their use for a variety of reconstructive and aesthetic purposes. The review is organized by system and examines the common indications, techniques, and outcomes pertaining to the application of ADMs in select anatomic areas. The final section briefly considers possible future directions for using biologics in plastic and reconstructive surgery.
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Affiliation(s)
- Shahryar Tork
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Ryan C Jefferson
- Department of Plastic and Reconstructive Surgery, Wexner Medical Center, The Ohio State University, Columbus, Ohio
| | - Jeffrey E Janis
- Department of Plastic Surgery, University Hospitals, Wexner Medical Center, Ohio State University, Columbus, Ohio
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Acellular dermal matrix for rhinophyma: Is it worth it? A new case report and review of literature. Int J Surg Case Rep 2019; 59:120-123. [PMID: 31129434 PMCID: PMC6536489 DOI: 10.1016/j.ijscr.2019.05.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/22/2019] [Accepted: 05/07/2019] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION nasal reconstruction after rhinophyma surgery could be challenging. In the last decade, some authors proposed the use of dermal substitutes, but only few case reports have been described throughout the Literature. PRESENTATION OF CASE we described a new case of severe and disfiguring rhinophyma treated by total excision and a two-step reconstruction by using acellular dermal matrix and subsequent full-thickness skin graft. Despite an overall improvement of the nasal shape and a good functional recovery were observed after 12 months of follow-up, the aesthetic outcome was not satisfactory and the patient required further surgical revisions. DISCUSSION the use of ADMs in rhinophyma poses some important aspects to be discussed. The resorption rate of the matrix and retraction rate of the skin graft make the final thickness of the neodermis unpredictable. Moreover the location of phymatous lesions and the extent of the surgical removal may strongly impact the final aesthetic outcome, often leading to a multistep procedure and patient dissatisfaction. CONCLUSION although we believe that ADM represents a simple and reliable alternative for surgical reconstruction after rhinophyma, basing on our clinical experience we suggested some important tips and tricks in order to avoid surgical revisions, and both surgeons and patients should be aware about the potential drawbacks of this technique.
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Johnson RM, Harrison LM, Anderson SR. The Adjunctive Use of Biologically Engineered Products in Plastic Surgery Practice. J Am Coll Clin Wound Spec 2018; 8:4-9. [PMID: 30276116 DOI: 10.1016/j.jccw.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Biologically engineered products are medical devices offer support and structure for wound healing by providing a scaffold for cell growth and proliferation. In the field of plastic surgery, these devices are being used to improve the outcomes of surgical closure in selected patients. The purpose of this article is to provide an overview of the source, indications, mechanisms, and outcomes of commonly used biologic products in wound healing. It will also provide an understanding of how biologics can be of value to patients with significant tissue defects requiring plastic surgery.
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Affiliation(s)
- R Michael Johnson
- Division of Plastic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Lucas M Harrison
- Division of Plastic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
| | - Spencer R Anderson
- Division of Plastic Surgery, Boonshoft School of Medicine, Wright State University, Dayton, OH, United States
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The Use of Double-Layer Collagen Membrane for the Improvement of Nasal Dorsum Skin Thickness and Texture in Primary Nose Surgery. J Craniofac Surg 2018; 28:731-733. [PMID: 28085763 DOI: 10.1097/scs.0000000000003374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To place a collagen membrane containing crushed nasal septal cartilage over the nasal dorsum to see how this graft can improve the results of visible postsurgical irregularities in thin skinned patients. METHODS Fifty-seven patients were treated between 2006 and 2010 (26 males and 31 females) whose ages ranged between 31 and 55 years old. They were divided into group a, defect <1 mm, group b defect between 1 and 2 mm, group c defect >3 mm. These patients presented intraoperative nasal dorsum irregularities that were corrected with 57 cartilage grafts in conjunction with collagen membrane. RESULTS All of our patients showed an initial over-correction. A dense network of collagen fiber bundles was observed running parallel to the surface of the membrane at the connective tissue-membrane interface. The clinical percentage of volume reabsorption was about 5% after 6 months, measured with clinical pictures and a clinical follow-up. No infection was noted, only 1 patient of dislocation was observed, and 5 patients required some refinements at the long-term follow-up. CONCLUSIONS In the authors' experience the use of bilayered combined cartilage and collagen membrane grafts gives the best aesthetic results with balanced tip projection and dorsum fullness, and avoids thickness and texture modification of the skin above the graft. The use of Bio-gide membrane avoids all problems related to the donor site and shortens surgical time.
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Susarla SM, MacIsaac ZM, Swanson E, Davidson E, Kumar A. Acellular Dermal Matrix as an Adjunct Material in Cleft Le Fort I Osteotomies. J Craniofac Surg 2017; 28:225-226. [PMID: 27997450 DOI: 10.1097/scs.0000000000003308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To evaluate the use of acellular dermal matrix in the management of nasal lining deficiency at the time of Le Fort I osteotomy. METHODS This was a retrospective cohort study of patients with residual/recurrent oronasal fistulae who underwent Le Fort I osteotomy. In instances where there was an inadequate volume of nasal mucosa for tension-free closure or for defects >1 cm in width, the acellular dermal matrix was used for augmentation. Demographic and cleft-related factors were recorded. Complications (recurrent fistula, infection, seroma, and wound dehiscence) were recorded. RESULTS Over the 3-year period, the authors used acellular dermal matrix to augment nasal lining in 8 subjects. The sample's mean age was 18.7 ± 3.1 years; 5 subjects were male. Six patients had bilateral cleft defects. The mean follow-up time was 20.2 ± 3.2 years. There were no episodes of infection, seroma, wound dehiscence, or recurrent fistula. CONCLUSION Acellular dermal matrix is a useful adjunct for managing nasal liningdeficiency at the time of Le Fort I osteotomy. There were no episodes of bone graft extrusion, infection, tooth loss, or bone graft loss. The Enemark scores improved significantly across both subsets (P <0.001). There was 1 recurrent fistula in the allograft bone alone group.Residual alveolar clefts and oronasal fistulae can be successfully managed at the time of Le Fort I osteotomy using allograft bone and acellular dermal matrix.
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Affiliation(s)
- Srinivas M Susarla
- *Craniofacial Center, Seattle Children's Hospital, Seattle, WA †Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA ‡Department of Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
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Skovsted Yde S, Brunbjerg ME, Gudmundsdottir G, Bazys M, Heje M, Engberg Damsgaard T. Dural repair using porcine ADM: two cases and a literature review. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2017; 4:5-8. [PMID: 28164146 PMCID: PMC5253515 DOI: 10.1080/23320885.2016.1278169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 12/29/2016] [Indexed: 10/31/2022]
Abstract
The use of acellular dermal matrices (ADM) for dural repair is very scantily described in the literature. We report two cases of dural repair using porcine ADM and a literature review. ADM and especially StratticeTM pliable may be a useful alternative to other dural substitutes. Further evaluation would be favorable.
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Affiliation(s)
- Simon Skovsted Yde
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Mette Eline Brunbjerg
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital , Aarhus , Denmark
| | | | - Mindaugas Bazys
- Department of Neurosurgery, Aarhus University Hospital , Aarhus , Denmark
| | - Martin Heje
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital , Aarhus , Denmark
| | - Tine Engberg Damsgaard
- Plastic Surgical Research Unit, Department of Plastic Surgery, Aarhus University Hospital , Aarhus , Denmark
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Dermal Matrix for Intraoral Lining Following Composite Mandibular Defect Reconstruction With Chimeric Fibular Osseocutaneous Flap. J Craniofac Surg 2016; 27:1711-1714. [PMID: 27763972 DOI: 10.1097/scs.0000000000002930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND This report aims to first present Integra as an adjunct to complex mandibular reconstruction for intraoral lining resurfacing, and to review the literature on the use of dermal matrices for mucosal resurfacing of the floor of the mouth. CLINICAL REPORT A 62-year-old female patient with previous ablation surgery for squamous cell carcinoma of the floor of the mouth, presented with extrusion of the mandibular plate through the chin skin and serious tongue tethering. The patient was managed with a chimeric osseocutaneous free fibula flap to restore the mandibular bone and chin skin defect, followed by a second-stage reconstruction of the intraoral defect with bilayer Integra. Complete release of tongue tethering was achieved enabling normal speech and deglutition and allowing for dental rehabilitation. CONCLUSIONS Integra was safely used as an alternative for intraoral lining, in composite mandibular reconstruction, downgrading reconstructive demands and offering optimal functional results.
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Seifer BJ, Wagner CT. Strain gradient development in 3-dimensional extracellular matrix scaffolds during in vitro mechanical stimulation. Comput Methods Biomech Biomed Engin 2016; 20:75-84. [PMID: 27353291 DOI: 10.1080/10255842.2016.1200563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study analyzed strain variations in 3D ECM scaffolds using a membrane-adherent model (MM) and a direct elongation model (DM). Computational models were solved for target strains from 1 to 10% at varied scaffold thicknesses and intra-scaffold slices. DM strain profiles were uniform within the scaffold and independent of thickness. However, a wide range of strains developed with substantial volume experiencing significantly off-target strain. MM strain profiles varied throughout the scaffold, exhibiting significantly reduced average strain with increasing thickness. These findings are important for tissue engineering studies since biological responses are commonly attributed to a single strain level that only partially describes the mechanical condition, making it difficult to develop precise causal relationships. Spatial strain variations and reduced average strain may warrant targeted sampling for cell response and should be taken into consideration by investigators using large-volume 3D scaffolds when engineering mechanically sensitive tissues.
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Affiliation(s)
- Benjamin J Seifer
- a Department of Mechanical Engineering , School of Engineering, The College of New Jersey , Ewing , NJ , USA
| | - Christopher T Wagner
- b Department of Biomedical Engineering , School of Engineering, The College of New Jersey , Ewing , NJ , USA
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Pham M, Eviston TJ, Clark JR. Reconstruction of limited parotidectomy defects using the dermofat graft. ANZ J Surg 2016; 87:E256-E260. [DOI: 10.1111/ans.13608] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 02/20/2016] [Accepted: 03/15/2016] [Indexed: 11/30/2022]
Affiliation(s)
- My Pham
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
| | - Timothy J. Eviston
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
| | - Jonathan R. Clark
- Department of Head and Neck Surgery; Chris O'Brien Lifehouse at RPA; Sydney New South Wales Australia
- Central Clinical School; The University of Sydney; Sydney New South Wales Australia
- South Western Clinical School; University of New South Wales; Sydney New South Wales Australia
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Free abdominal fat transfer for partial and total parotidectomy defect reconstruction. Laryngoscope 2016; 126:2694-2698. [DOI: 10.1002/lary.26025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 03/06/2016] [Accepted: 03/16/2016] [Indexed: 11/07/2022]
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Fritz MA, Rolfes BN. Microvascular Reconstruction of the Parotidectomy Defect. Otolaryngol Clin North Am 2016; 49:447-57. [DOI: 10.1016/j.otc.2015.10.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Irvine LE, Larian B, Azizzadeh B. Locoregional Parotid Reconstruction. Otolaryngol Clin North Am 2016; 49:435-46. [DOI: 10.1016/j.otc.2015.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Damsgaard TE, Hammer-Hansen N, Eschen GT, Kiil BJ, von Oettingen G. Porcine acellular dermal matrix for reconstruction of the dura in recurrent malignant schwannoma of the scalp. EUROPEAN JOURNAL OF PLASTIC SURGERY 2016. [DOI: 10.1007/s00238-015-1128-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Infection in the Nasal Tip Caused by Acellular Dermal Matrix. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2016; 3:e581. [PMID: 26894006 PMCID: PMC4727690 DOI: 10.1097/gox.0000000000000573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 11/09/2015] [Indexed: 11/26/2022]
Abstract
A 19-year-old female patient visited our clinic for rhinoplasty. She complained about her low take-off point, which was apparent in profile view, and wanted slight tip projection. She refused additional cartilage harvesting from ears or ribs but consented to the use of homologous tissue, including acellular dermal matrix, for her dorsum and tip. Septoturbinoplasty was performed, and only a very small amount of septal cartilage could be harvested. It was used as both the columellar strut and the alar rim graft. Nasal dorsum and tip were augmented with acellular dermal matrix. Three months postoperatively, she experienced a few episodes of edema and redness on her nasal tip, followed by pus exudation from the nasal skin. Six months postoperatively, she underwent revision rhinoplasty for removal of inflamed grafts, and onlay tip graft with homologous rib cartilage was performed. Nasal dorsum or tip grafts are an integral part of Asian rhinoplasty. Autogenous tissue is the gold standard for grafting materials. However, the limited availability of autogenous tissue and the preference of patients and surgeons for artificial surgical implants make Asian rhinoplasty challenging. Unavailability of autogenous cartilage and patient refusal of artificial implants led to the use of acellular dermal matrix (ADM) in the nasal dorsum and tip for this case. This is the first report of postoperative complication because of infection rather than absorption after ADM use.
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Lee JH, Choi SK, Kang SY. Reconstruction of Chronic Complicated Scalp and Dural Defects Using Acellular Human Dermis and Latissimus Dorsi Myocutaneous Free flap. Arch Craniofac Surg 2015; 16:80-83. [PMID: 28913227 PMCID: PMC5556854 DOI: 10.7181/acfs.2015.16.2.80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/29/2015] [Accepted: 08/04/2015] [Indexed: 11/11/2022] Open
Abstract
We present reconstruction of a complicated scalp-dura defect using acellular human dermis and latissimus dorsi myocutaneous free flap. A 62-year-old female had previously undergone decompressive craniectomy for intracranial hemorrhage. The cranial bone flap was cryopreserved and restored to the original location subsequently, but necessitated removal for a methicillin-resistant Staphylococcal infection. However, the infectious nidus remained in a dermal substitute that was left over the cerebrum. Upon re-exploration, this material was removed, and frank pus was observed in the deep space just over the arachnoid layer. This was carefully irrigated, and the dural defect was closed with acellular dermal matrix in a watertight manner. The remaining scalp defect was covered using a free latissimus dorsi flap with anastomosis between the thoracodorsal and deep temporal arteries. The wound healed well without complications, and the scalp remained intact without any evidence of cerebrospinal fluid leak or continued infection.
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Affiliation(s)
- Jun Hee Lee
- Department of Plastic and Reconstructive Surgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Seok Keun Choi
- Department of Neurosurgery, Kyung Hee University School of Medicine, Seoul, Korea
| | - Sang Yoon Kang
- Department of Plastic and Reconstructive Surgery, Kyung Hee University School of Medicine, Seoul, Korea
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Abstract
Over 100 million patients acquire scars in the industrialized world each year, primarily as a result of elective operations. Although undefined, the global incidence of scarring is even larger, extending to significant numbers of burn and other trauma-related wounds. Scars have the potential to exert a profound psychological and physical impact on the individual. Beyond aesthetic considerations and potential disfigurement, scarring can result in restriction of movement and reduced quality of life. The formation of a scar following skin injury is a consequence of wound healing occurring through reparative rather than regenerative mechanisms. In this article, the authors review the basic stages of wound healing; differences between adult and fetal wound healing; various mechanical, genetic, and pharmacologic strategies to reduce scarring; and the biology of skin stem/progenitor cells that may hold the key to scarless regeneration.
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Acellular dermal matrices and revision parotid surgery. Laryngoscope 2015; 125:2123-4. [DOI: 10.1002/lary.25301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/03/2015] [Accepted: 03/09/2015] [Indexed: 11/07/2022]
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Saab IR, Sarhane KA, Ezzeddine HM, Abu-Sittah GS, Ibrahim AE. Treatment of a paediatric patient with a distal lower extremity traumatic wound using a dermal regeneration template and NPWT. J Wound Care 2014; 23:S5-8. [PMID: 25289652 DOI: 10.12968/jowc.2014.23.sup10.s5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Degloving injuries are common in trauma and represent a spectrum of complex wounds, the management of which may be highly challenging especially in the paediatric population. In severe injuries leading to wounds reaching tendon and bone, vascularity is compromised precluding traditional wound management, and sometimes necessitating amputation. This report highlights the use of a dermal regeneration template combined with vacuum-assisted closure (VAC) in the treatment of complex traumatic degloving wounds. Here, we present a case of a five-year-old boy who sustained a high-energy shear injury to his lower extremity that resulted in an extensive degloving wound involving the distal third of his leg and the dorsum of his foot. After debridement, the patient underwent VAC combined with a dermal skin substitute placement, followed by split-thickness skin grafting. The extremity healed with no complications and without the need for amputation or flap reconstruction, achieving satisfactory recovery of range of motion and favourable cosmetic results.
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Affiliation(s)
- I R Saab
- General Surgery Resident, Department of Surgery, Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Yin D, Tang Q, Wang S, Li S, He X, Liu J, Liu B, Yang M, Yang X. Xenogeneic acellular dermal matrix in combination with pectoralis major myocutaneous flap reconstructs hypopharynx and cervical esophagus. Eur Arch Otorhinolaryngol 2014; 272:3457-61. [DOI: 10.1007/s00405-014-3355-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
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Tracy JC, Kim WS, Scott AR. The Versatility of Acellular Fetal Bovine Dermal Matrix for Head and Neck Surgical Reconstruction in Children. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ijcm.2014.518143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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