First-time-use-of-integra-dermal-graft-as-an-alternative-for-buccal-mucosal-graft-urethroplasty-a-rare-case-report

The use of buccal mucosa grafts in urethral reconstruction for complex anterior urethral strictures has gained popularity over the years with very good outcomes reported in literature. Simultaneously newly launched integra dermal graft is been used as Onlay flap for postoperative hypospadias urethro-cutaneous fistula closure as reported in world wide literature. The aim of this case report is to compare pros and cons of use of Integra Dermal Graft as an alternative to staged Buccal mucosal graft urethroplasty in case of 13 years old boy with multiple postoperative hypospadias fistulae.

Failure of Dermal Allograft Repair of Massive Rotator Cuff Tears in Magnetic Resonance Imaging and Clinical Assessment

BACKGROUND: Massive retracted rotator cuff tears represent a therapeutic dilemma, particularly in the young and middle-aged patients who are not appropriate for a reverse total shoulder replacement. Interposition grafting using human dermal allograft offers an alternative treatment. METHODS: A retrospective review of all patients who underwent interposition grafting using human dermal allograft between December 2013 and May 2015 for massive rotator cuff tears at our tertiary referral center was performed. Preoperative and 6 month postoperative magnetic resonance imaging (MRI) assessments were performed in all patients, with postoperative graft integrity being the primary outcome measure. Clinical evaluation was performed using the Oxford shoulder score, Constant score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. RESULTS: The mean age at the time of follow-up was 54 years. On MRI, 84% of grafts were seen to have failed at 6 months. Strength was grossly reduced on the operative side when supraspinatus and subscapularis were tested; despite this, Constant score (mean, 48.2) was comparable to that in the previous reports. DASH and Oxford scores were a mean of 24.94 and 37.16, respectively. CONCLUSIONS: Based on these results, in particular the MRI findings, we cannot advocate the use of dermal allograft as an interposition graft for the repair of massive rotator cuff tears.

Comparative Study on Acellular Dermal Graft Versus Propylene Mesh Both Either Loaded or Unloaded with BM-MSCs in Healing of Skull Bone Defect in Rats: Histological and Immunohistochemical Study

Bone defect occurs as a consequence of many conditions. Diseased bones don’t heal properly and defects in face area need proper bone reconstruction to avoid psychological and social problems. Tissue engineering is an emerging new modality of treatment. We thought to study different methods to fill skull bone defect in rats in order to find the most safe and effective method. So, this study was designed to evaluate the efficacy of acellular dermal graft (ADM) versus propylene mesh both either loaded or unloaded with bone marrow derived mesenchymal stem cells (BM-MSCs) in healing of skull bone defect of a 5 mm diameter. The study included 36 adult male Wistar albino rats that were divided into three groups according to the way of filling skull bone defect. Group I: Ia (sham control), Ib (negative control). Group II: IIa (unseeded propylene), IIb (seeded propylene) and Group III: IIIa (unseeded ADM), IIIb (seeded ADM). The trephine operation was done on the left parietal bone. Specimens were collected four weeks postoperative and processed for H&E, osteopontin immunohistochemistry and scanning electron microscope. Morphometric and statistical analysis were also performed. After studying the results of the experiment, we found that propylene mesh and ADM were suitable scaffolds that could support new bone formation in clavarial bone defect. Healing of skull bone defect was better in rats that received seeded scaffolds more than rats with unseeded scaffolds. The seeded ADM showed significant increase in bone forming activity as confirmed by histomorphometric and statistical results.

The Effect of Basic Fibroblast Growth Factor in Acellular Human Dermal Grafts in Rats

PURPOSE: Acellular human dermis is very useful implant for use in plastic and reconstructive surgery. However, the volume of acellular human dermis graft is known to decrease for a long time. Basic fibroblast growth factor (bFGF) is a polypeptide that enhances the collagen synthesis and angiogenesis. In the current study we examined whether bFGF could improve the survival of acellular human dermis(SureDerm(R)) by increasing angiogenesis of the graft. METHODS: Forty rats were divided into two groups (control and bFGF). A 2-mm thick piece of SureDerm(R) was cut into smaller pieces that were 15x5mm in size. Two subcutaneous pockets were made on the back of each rat. Grafts sprayed with bFGF were implanted in the bFGF group and injected with bFGF after transplantation every 3 days for 2 weeks. In the control group, the grafts were treated with phosphate-buffered saline(PBS) instead of bFGF. Four days, and 1, 4, and 12 weeks after the implantation, the grafts were harvested and gross and histologic examinations were performed. Inflammation grade, graft thickness, neocollagen density, and neocapillary count were measured. RESULTS: The bFGF group displayed more rapid accumulation of inflammatory cells with a higher density of neocapillaries, and increased active collagen synthesis. After 12 weeks, the thickness of the grafts in the control and bFGF groups was 75.15+/-4.80% and 81.79+/-5.72%, respectively, in comparison to the thickness before transplantation. There was a statistically significant difference between both groups(p<0.05). CONCLUSION: bFGF was effective in reducing the absorption of acellular human dermal grafts by increasing angiogenesis and accelerating engraftment. In conclusion, bFGF may be a good tool for use in acellular human dermal graft transplantation for reconstructive surgery involving soft-tissue defects.

Absorption Rates of Various-thickness Human Acellular Dermal Grafts(SureDerm(R))

The human acellular dermal graft provides safe and lasting volume gain for soft tissue augmentation in the face. However, variable amounts of the graft are gradually reabsorbed in the host tissue. The purpose of this experiment is to evaluate the absorption rates of the implanted acellular dermal grafts (SureDerm(R)) and to estimate the amount of overcorrection in the soft tissue augmentation. Twenty-eight New Zealand white rabbits were divided into 4 groups. A 2.0x 2.5 cm sized subcutaneous pocket was created on the dorsal surface of the ear. 10x10 mm sized SureDerm(R) sheets, each 1 mm, 2 mm, 3 mm and 4 mm in thickness were implanted into the pockets. Ear thickness was measured by Thickness Gauze at the time of pre-operative, immediate post-operative, 4, 8 and 12 weeks after implantation. Full thickness ear was harvested in 4, 8 and 12 weeks and examined histologically for graft thickness, host tissue ingrowth, neocollagen synthesis and inflammatory reaction. Ear thickness was mildly increased due to swelling and inflammatory reaction in the initial 4 weeks in all groups and then was decreased in 12 weeks by 84%. However, there was a significant decrease in the thickness of the graft itself (43%). There was no significant difference in the ear thickness among the groups (p<0.05) with time. Histological analysis of implanted SureDerm(R) sheets demonstrated progressive neovascularization, fibroblast infilteration, neocollagen bundle synthesis and organization. Our experimental study suggests that the absorption rate of SureDerm(R) is quite uniform regardless of the thickness of the graft. The amount of overcorrection is relatively predictable and 18% of overcorrection seems to be needed for satisfactory result.

Reconstruction of Septal Perforation with Alloderm / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The closure of nasal septal perforation is a significant surgical challenge with high failure rates. Acellular human dermal graft (Alloderm) placed between mucoperichondrial advancement flaps may be an alternative. The purpose of this study was to investigate the usefulness of Alloderm for the repair of nasal septal perforation. MATERIALS AND METHODS: Seven consecutive patients with septal perforation who received the septal perforation repair with Alloderm were included in this study. The causes of septal perforations were previous nasal surgeries, trauma, chemical irritation, inflammation, or unknown. Follow-up periods ranged from 7 to 36 months. RESULTS: Six of seven patients had successful outcomes with complete closure of their perforations. The remaining one patient had an incomplete closure, but the size of the performation was reduced with no further symptoms. CONCLUSION: AIloderm can be used as a connective tissue and interpositional grafts in the repair of septal perforations with high success rates. Therefore, Alloderm is the viable alternative for the closure of nasal septal perforations.

Postoperative Sensibility Test in Patients Undergoing Reconstruction of Donor Defect of Flap Surgery with an Acellular Allograft Dermal Matrix ( AlloDerm )

Numerous choices exist for closing any wound, so the surgical challenge is that of selecting the optimal method. It is necessary to balance multiple factors, including recipient site requirements, donor site morbidity, operative complexity, and patient factors. Limiting the donor site morbidity is emphasized in the aphorism "Never rob Peter to pay Paul unless Peter can afford it. Certainly, documented cases exist in which donor site morbidity exceeds the original recipient problem, necessitating a second procedure to reconstruct the donor site. The flap survived and the wound was closed, but the donor site was often worse than the original defect. Numerous donor site complications are often overlooked while one concentrates on the successful flap transfer. The standard method for grafting donor wound after harvesting of a flap uses thick split-thickness skin grafts. This method, however, creates an additional comlication-prone wound at the donor sites. Donor sites for grafting can be painful and may develop infection, hypertrophic scarring, blistering. The problem of donor sites scar hypertrophy occurs most frequently when a graft is taken at more than 0.012 inch thick, leaving a residual dermal bed is too thin. AlloDerm processed allograft dermis was developed as a permanent dermal transplant for full thickness wounds. Between 1997 and 1999, we have applied AlloDerm grafts and ultra-thin autografts on 11 patients with donor sites after harvesting flaps. All the composite AlloDerm /autograft were noted to be firmly adherent except 2 cases, which showed focal loss of the grafts and was healed after second graft. AlloDerm exhibited a high percentage take and supported an overlying ultra thin split-thickness skin autograft, applied simultaneously. By providing a dermal replacement, the grafted dermal matrix permitted a thin autograft from the donor site. The ultra-thin autografts leave donor sites that heal faster and with fewer complication. AlloDerm dermal transplants exhibit excellent elastisity and good pigmentation with minimal scarring or wound contracture. Sensory reinnervation after the composite AlloDerm/autograft was not fully recovered. The reason was that these grafts were placed on the bone or tendon exposed sites which were not sufficiently well- innervated graft bed. The high reproducibility of excellent results with this composite graft, coupled with the reduced trauma and rapid healing of donor sites associated with ultra-thin autograft STSG, has made composite grafting with the use of AlloDerm dermal transplants our new method of choice for treatment of donor defects of flap surgery.

Reconstruction of the Defect with Dermal Graft After the Removal of Subungual Squamous Cell Carcinoma / 대한피부과학회지

Squamous cell carcinoma of the nail bed is a low grade, slowly progressive, malignant neoplasm. A 66-year-old man had nail lesion on his right thumbnail for two years. After partial nail avulsion, an incisional biopsy was done. The histologic diagnosis was a squamous cell carcinoma. A radiological examination of digit was normal and no lymphadenopathy was palpable. The lesion was totally excised and surgical defect of nail bed was reconstructed by dermal graft. There was no recurrence of tumor till one year after surgery and out-look of nail recovered almost normal. When the underlying malignancy is suspected, it is necessary to examine the nail bed after partial nail avulsion. And application of dermal graft may be useful procedure for regeneration of nail plate when there is a large nail bed defect after excision.

Reconstruction of the Defect with Dermal Graft After the Removal of Subungual Squamous Cell Carcinoma / 대한피부과학회지

Squamous cell carcinoma of the nail bed is a low grade, slowly progressive, malignant neoplasm. A 66-year-old man had nail lesion on his right thumbnail for two years. After partial nail avulsion, an incisional biopsy was done. The histologic diagnosis was a squamous cell carcinoma. A radiological examination of digit was normal and no lymphadenopathy was palpable. The lesion was totally excised and surgical defect of nail bed was reconstructed by dermal graft. There was no recurrence of tumor till one year after surgery and out-look of nail recovered almost normal. When the underlying malignancy is suspected, it is necessary to examine the nail bed after partial nail avulsion. And application of dermal graft may be useful procedure for regeneration of nail plate when there is a large nail bed defect after excision.

Two cases of Peyronie's disease treated by auto-dermal graft technique / 대한비뇨기과학회지

Peyronie's disease is characterized by localized fibrosis in the tunica albuginea of the corpus cavernosum with no confirmed etiology. We report 2 cases of Peyronie's disease, in which surgical1y corrected with the dermal graft technique. One patient is performed with the penile prosthesis be. cause of sexual impotence after correction of penile curvature.