J Reconstr Microsurg 2012; 28(02): 139-144
DOI: 10.1055/s-0031-1289167
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acellular Dermal Matrix and Negative Pressure Wound Therapy: A Tissue-Engineered Alternative to Free Tissue Transfer in the Compromised Host

Zachary K. Menn
1   Institute for Reconstructive Surgery, The Methodist Hospital, Houston, Texas
,
Edward Lee
1   Institute for Reconstructive Surgery, The Methodist Hospital, Houston, Texas
,
Michael J. Klebuc
1   Institute for Reconstructive Surgery, The Methodist Hospital, Houston, Texas
› Author Affiliations
Further Information

Publication History

20 June 2011

17 July 2011

Publication Date:
29 September 2011 (online)

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Abstract

Free tissue transfer has revolutionized lower extremity reconstruction; however, its use in elderly patients with multiple medical problems can be associated with elevated rate s of perioperative morbidity and mortality. This study evaluates the use of acellular dermal matrix (ADM) in conjunction with negative pressure wound therapy (NPWT) and delayed skin graft application as an alternative to free tissue transfer in this compromised population. Bilayer, ADM (Integra, Plainsboro, NJ) was used in conjunction with NPWT (Wound V.A.C, Kinetic Concepts Inc., San Antonio, TX) to achieve vascularized coverage of complex lower extremity wounds with denuded tendon and bone in elderly, medically compromised patients. Following incorporation, the matrix was covered with split-thickness skin graft. Four patients (age range, 50 to 76 years) with multiple medical comorbidities were treated with the above protocol. The average time to complete vascularization of the matrix was 29 days. Definitive closure with split-thickness skin graft was achieved in three patients and one wound healed by secondary intention. No medical or surgical complications were encountered and stable soft tissue coverage was achieved in all patients. This early experience suggests that dermal substitute and NPWT with delayed skin graft application can provide a reasonable tissue-engineered alternative to free tissue transfer in the medically compromised individual.