Clinical evaluation of root coverage using coronally positioned flap associated with acellular dermal matrix allograft in single-type recession defects / Evaluación clínica del recubrimiento radicular mediante colgajo desplazado coronal asociado a injerto dérmico acelular en recesiones únicas

ABSTRACT The aim of this study was to conduct a retrospective assessment of the clinical results at 6,12 and 24 months of root coverage in single gingival recessions using coronally positioned flap and acellular dermal matrix allograft. Clinical records were collected from 16 patients with single gingival recessions who visited a private practice in Periodontics in 2005 and 2006. They were treated through a coronally positioned flap and acellular dermal matrix allograft. The following periodontal parameters were recorded at baseline, 6, 12 and 24 months: Recession Depth, Recession Width, Probing Depth, Clinical Attachment Level, Keratinized Tissue Width, Plaque Index, Gingival Index and Sensitivity. The percentage of root coverage was 91.18 ± 21.26 at 6 months, 90.18 ± 22.04 at 12 months and 90.83 ± 18.41 at 24 months. Complete root coverage was 81% (13 out of 16) at 6 and 12 months. At 24 months, complete root coverage was 75% (9 out of 12). The plaque and gingival indexes did not vary significantly between baseline and measurement times. Probing depth was maintained at healthy levels during the months of follow-up. Sensitivity decreased at 12 months (4 of 16) compared to baseline (14 of 16), and was maintained at 2 years (2 of 12). This retrospective study showed that acellular dermal matrix allograft could be considered a useful alternative for the treatment of single gingival recessions, reducing the discomfort and morbidity associated with the palatal donor site.

RESUMEN El objetivo de este trabajo fue evaluar retrospectivamente los resultados clínicos del recubrimiento radicular en recesiones únicas mediante el uso de colgajo desplazado coronal y matriz dérmica acelular a los 6,12 y 24 meses. Se recolectaron las historias clínicas de 16 pacientes que presentaban recesiones gingivales únicas, concurrentes a un consultorio privado de Periodoncia en los años 2005 y 2006. Fueron tratados utilizando colgajo desplazado coronal y matriz dérmica acelular. Previamente se registraron los siguientes parámetros periodontales: Altura de la recesión, Ancho de la recesión, Profundidad al sondaje, Nivel Clínico de inserción, Ancho del tejido queratinizado, Indice de placa, Indice gingival y Sensibilidad. Los datos se obtuvieron nuevamente a los 6, 12 y 24 meses. El porcentaje de recubrimiento radicular obtenido a los 6 meses fue de 91,18 ± 21,26, de 90,18 ± 22,04 a los 12 meses y 90,83 ± 18,41 a los 24 meses. La cobertura radicular completa fue de 81% (13 de 16) a los 6 y 12 meses, y fue de 75% a los 24 meses (9 de 12). Los índices de placa y gingival no variaron significativamente entre el inicio y los diferentes intervalos de tiempo. La profundidad al sondaje se mantuvo en niveles compatibles con salud durante los meses de seguimiento. Se logró disminuir la sensibilidad a los 12 meses (4 de 16) respecto al inicio del tratamiento (14 de 16), manteniendo dicha proporción a los 2 años (2 de 12). El presente estudio retrospectivo mostró que el uso de la matriz dérmica acelular podría ser considerado una alternativa predecible para el tratamiento de recesiones gingivales únicas, reduciendo el disconfort y la morbilidad asociada al sitio donante palatino.

Use of regenerative tissue matrix as an oral layer for the closure of recalcitrant anterior palatal fistulae: a pilot study

OBJECTIVES: To evaluate the effectiveness of regenerative tissue matrix (Alloderm) as an oral layer for difficult anterior palatal fistula closure. MATERIALS AND METHODS: The authors have tested the feasibility of a novel surgical technique of adding a regenerative tissue matrix (Alloderm) as an oral layer for closure of recalcitrant large anterior palatal fistulae and report the outcome of the first 12 patients in this pilot study. Patients with recurrent large fistula who otherwise would require either a local pedicled flap, free flap, or an obturator were treated with this technique and followed up for at least 6 months to monitor the progress of healing. RESULTS: Of the 12 patients, 8 patients (66.7%) had complete closure of the fistula, and 2 patients (16.7%) showed reduction in size of the fistula to the extent that symptoms were eliminated, for an overall success rate of 83.3% (10/12 patients). Premature graft loss and recurrence of the fistula were noted in 2 patients (16.7%). CONCLUSION: Alloderm provided an adequate barrier allowing healing to occur unimpeded and allowed closure of the palatal fistula. In our experience, this new technique using regenerative tissue matrix as an adjunct to the oral layer in large anterior palatal fistula has an advantage compared to other more invasive complex procedures and has been shown to provide satisfactory results.

Human Acellular Dermis versus Submuscular Tissue Expander Breast Reconstruction: A Multivariate Analysis of Short-Term Complications

BACKGROUND: Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry. METHODS: Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. RESULTS: A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P<0.01). CONCLUSIONS: The NSQIP database provides large-scale, multi-institutional, independent outcomes for acellular dermis and submuscular breast reconstruction. Both thirty-day complication profiles and risk factors for post operative morbidity are similar between these two reconstructive approaches.

Results of Acellular Dermal Graft (Surederm(R)) Implantation Laryngoplasty in Adhesive True Vocal Cord / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study investigated the quality of life improvement after Surederm(R) implantation laryngoplasty in patients with adhesive true vocal cord. SUBJECTS AND METHOD: A prospective study was conducted in 18 patients with adhesive vocal cord who underwent laryngoplasty using Surederm(R). The exploration of adhesive lesions or lamina propria through the fenestration allowed for the creation of a pocket for Surederm(R) implantation within the intermediate layer of the lamina propria. Analyzed were the preoperative and postoperative parameters including the Korean-Voice Handicap Index, jitter, shimmer, noise to harmonic ratio, maximum phonation time and mucosal waves in stroboscopic findings. RESULTS: During the follow-up time of 12 months, the patients demonstrated excellent long-term vocal fold augmentation and significant improvement in all parameters measured. There is improved pliability of the vocal fold with good oscillation in all patients. CONCLUSION: According to these results, it is suggested that Acellular Dermal Graft (Sure-derm(R)) implantation laryngoplasty can be a stable and effective surgical treatment for adhesive true vocal cord.

Complications Following BellaGen(TM) Injection

BellaGen(TM) is an injectable acellular dermal matrix granule derived from donated human skin tissue that was recently developed for soft tissue augmentation. Its use has been sporadically reported in penile girth enhancement procedures. Many cases of complications have been reported after injecting acellular dermal matrices like AlloDerm or SureDerm(TM) but few reports on complications associated with BellaGen(TM) injection. We report here on penile skin inflammation and necrosis following augmentation phalloplasty with BellaGen(TM), which developed 3 days after the injection and persisted for more than 2 weeks. The patient had a 15 year history of type 2 diabetes mellitus, and he was treated with oral antibiotics and wet dressings with KMNO4 solution to combine preservation of the remaining penile soft tissue with debridement of avascular tissue. The lesion improved with this treatment, but the patient experienced pain for about 2 weeks. All patients should be informed of the potential complications with the use of injectable acellular dermal matrices before treatment. Patient selection for augmentation is also important to have the most desirable results.

Implant Breast Reconstruction Using Porcine Dermal Matrix(Permacol(R)): A Comparative Study with Acellular Cadaveric Dermis(AlloDerm(R))

PURPOSE: The use of tissue expander/implant in breast reconstruction using tissue expander-implant is one of the most common surgical procedures. The use of AlloDerm as a sling to reestablish the lower pole of the pectoralis major muscle results a decrease in morbidity compared with more invasive procedures. However the use of AlloDerm is more expensive than other options. We decided to compare AlloDerm with Permacol, which has been safely used in human body reconstruction and is less costly than AlloDerm. METHODS: After mastectomy, the inferolateral origin of the pectoralis major muscle was elevated. Either AlloDerm or Permacol was sutured to the chest wall at the level of the previously marked inframammary fold. The lower border of the pectoralis major muscle and the upper portion of the crescent-shaped piece of either AlloDerm or Permacol was sutured together using a tension free technique, and a tissue expander was subsequently inserted into the subpectoral-subAlloDerm (or Permacol) dual pocket. RESULTS: AlloDerm was used in twenty-one patients(28 breasts) and Permacol was used in six patients(11 breasts) for tissue expander-implant breast reconstruction. During the mean follow-up period of 17 months(8~25 months). Two infections(7%) occurred in AlloDerm cases and four infections(36%) occurred in Permacol cases. CONCLUSION: This study is the first comparison of tissue expander/implant breast reconstruction using AlloDerm and Permacol. The use of Permacol resulted in more postoperative infection compared with the use of AlloDerm. This report is still limited with the small number of cases studied.

Refinement of Deep Nasolabial Fold by Soft Tissue Augmentation

A nasolabial fold is one of the most typical process on an aged face. Face lifting, one of the frequent methods of correcting nasolabial folds, involves innate burdens as it is a form of surgery and involves many difficulties related to the surgical procedure in improving the nasolabial fold. Therefore, soft tissue augmentation is increasingly being performed on nasolabial folds. We achieved a good outcome and a high level of patient satisfaction after correcting a nasolabial fold using Surederm(TM), AlloDerm(R), and a autologous fat strip. From October 2002 to December 2010, a total of 19 patients have inserted Surederm(TM), AlloDerm(R) and a autologous fat strip in nasolabial fold using our special instrument. Sex, age, patient's satisfaction, and side effects were examined and the outcome was assessed by two plastic surgeons, excluding these authors, in a blind manner by comparing the nasolabial fold in the pre- and post- treatment pictures. Of the 19 patients, 1 was male and 18 were female. Their mean age was 45 years(range: 21~61 years). They showed a relatively high level of satisfaction with the outcomes. In one patient, although the Surederm(TM) was removed due to infection, the patient's deep nasolabial fold was corrected even after the Surederm(TM) removal. The two plastic surgeons judged that the nasolabial folds of the 19 patients improved considerably. Our procedure is more invasive than filler or fat injection. But with this procedure, augmentation effect can be lasting longer. So, the outcome was satisfactory.

Treatment of Complex Open Wounds Using AlloDerm(R) in Hand and Foot

PURPOSE: The purpose of this study is to evaluate the functional and aesthetic outcomes of the reconstruction of complicated open wounds with exposure of the bone, periosteum, or tendon using AlloDerm(R) and skin graft in hand and foot. MATERIALS AND METHODS: Seven cases of hand and 4 cases of foot were treated with combined AlloDerm(R) graft and split thickness skin graft in a single stage for managing the soft tissue defect of extremities where bone, periosteum, or tendon were exposed but flap operation was not feasible. The mean postoperative follow-up period was 30 months (range: 14-48 month). Postoperatively, we assessed graft taking rate, wound healing process, and the recovery of motion of hand and foot. RESULTS: AlloDerm(R) and skin graft were readily assimilated into the wound in all cases. The mean postoperative range of motions of the 5 fingers with exposed digital tendons were 89.2% of the normal side. Reconstructions of wound in the foot were successfully settled without unstable scar or ulcer in all cases. CONCLUSION: Composite grafting with AlloDerm(R) and autologous skin graft for reconstruction of complex open wound in hand and foot where deep structures are exposed provides stable reconstruction of the wound with high taking rate, successful recovery of tendon gliding motion by preventing adhesion.

Reconstruction of Burn Scar Contracture with Split-Thickness Skin Graft Taken from the Scalp and Alloderm(R): Case Report

A 13 year old male patient had limitation of foot motion due to burn scar contracture on right ankle area. The scar contracture was released and Alloderm(R) was applied over the raw surface. Split thickness skin was harvested from the scalp and harvested skin was applied over Alloderm(R). Epithelialization of donor site began from the post-op 5th day. Graft was well taken without any problem. There was no complications during 6 months of follow-up period.

Alloderm / Alloderm

Es de enorme transcendencia el advenimiento de las técnicas de cirugía plástica en periodoncia en el afán de buscar refinamiento técnicos quirúrgicos reclamados no solo por los pacientes sino por los mismos especialistas y que resulten en lograr el aumento de inserción sin migración gingival, dando de esta manera una solución favorable a los desagradables aspectos estéticos que quedaban como secuelas de la enfermedad periodontal o de la misma técnica quirúrgica terapéutica que trataban a la periodontitis. los defectos estéticos más comunes ocurren por una alteración del contorno gingival normal que en estado de salud cubre el límite amelocementario de los dientes y son las recesiones gingivales que ocurren por exceso del tejido gingival. El uso de Alloderm viene a constituir una opción de gran importancia entre los diferentes tipos de injertos utilizados en las distintas técnicas quirúrgicas plásticas. El mismo presenta grandes ventajas que conviene mencionar como el que no quiere sitio donante, menor tiempo quirúrgico, menor dolor posoperatorio, posibilidad de cobertura en recesiones múltiples de una sola vez y es estético. Aunque siempre compite con un injerto de eficacia comprobada como son los injertos del tejido conectivo subepitelial, su uso esta indicado fundamentalmente cunado el objetivo quirúrgico es lograr el cubrimiento de las recesiones gingivales sean localizadas o múltiples en dientes o implantes, aumento de encía insertada, profundización del vestíbulo, corregir el biotipo periodontal delgado y lograr el aumento de la encía queratinizada. El objetivo de este trabajo es de facilitar a quienes le consultan, no sólo los conceptos básicos para su utilización sino también el aporte de las conclusiones de los últimos trabajos originales que valoran las distintas propiedades y características de este noble material de injerto.

A Case of Septal Perforation Reconstructed with Alloderm Interposition Graft Resulted from Magnetic Nasal Foreign Bodies / 대한이비인후과학회지

Nasal cavity foreign bodies are common accidents in children, especially between the newly born and four years of age, and sometimes lead to complications such as epistaxis, vestibulitis, sinusitis bronchoaspiration and nasal septal damage etc. Diagnosis is often made with anterior rhinoscopy, but sometimes nasal fibroendoscopy and imaging may be useful. If the diagnosis is confirmed, prompt foreign body removal should be done to avoid complications. We have recently experienced a case of nasal septal perforation secondary to magnetic nasal foreign bodies attracting each other across the nasal septum. After the removal of foreign bodies, the nasal septal perforation was repaired with acellular human dermal allograft.

Tissue Engineering of Injectable Soft tissue Filler: Using Adipose Stem Cells and Micronized Acellular Dermal Matrix

In this study of a developed soft tissue filler, adipose tissue equivalents were constructed using adipose stem cells (ASCs) and micronized acellular dermal matrix (Alloderm). After labeling cultured human ASCs with fluorescent green protein and attaching them to micronized Alloderm (5X10(5) cells/1 mg), ASC-Alloderm complexes were cultured in adipogenic differentiation media for 14 days and then injected into the dorsal cranial region of nude male mice. The viabilities of ASCs in micronized Alloderm were determined at 1, 4, 7, and 14 days, and complexes, which had been cultured for 14 days and implanted in vivo for 2 months, were histologically evaluated by light, confocal, and scanning electron microscopy. The viabilities represented that ASCs in micronized Alloderm were alive during the culture period. ASC-Alloderm complexes cultured for 14 days contained round cells with large lipid vesicles by light microscopy and many spherical cells by SEM. ASCs in implanted ASCAlloderm complexes harvested from mice at 2 months postinjection were histologically found to have differentiated into adipocytes which had green fluorescence dye. Micronized Alloderm may be found useful as scaffold for human ASCs when constructing fat tissue for three-dimensional soft tissue filling. The present study suggests that ASC-Alloderm complexes can be used as injectable three-dimensional soft tissue fillers.

Implant Breast Reconstruction using AlloDerm Sling; Clinical Outcomes and Effect to Capsular Formation

PURPOSE: Breast surgeons usually insert tissue expander or implant beneath the subpectoral-subcutaneous dual plane in breast reconstruction. But sometimes it happens unsatisfactory lower pole fullness, asymmetric inframammary fold and breast shape. To solve all the problem like these, we introduce implant breast reconstruction using AlloDerm sling. METHODS: The AlloDerm sling was used in 13 patients and 18 breasts for implant breast reconstruction. After mastectomy, costal and lower sternal insertion of pectoralis major muscle was detached. Rehydrated AlloDerm was sutured to the chest wall and serratus anterior fascia at the level of inframammary fold downward and to lower border of the pectoralis major muscle upward like crescent shape with tension free technique after implant insertion into the subpectoral-subAlloDerm dual pocket. And we evaluate subpectoral capsule and subAlloDerm capsule histologically for the capsular thickness, amount of myofibroblast and TGF-beta expression. RESULTS: We make satisfactory lower pole fullness, symmetric inframammary fold and breast shape using AlloDerm sling. SubAlloDerm capsule was thin than subpectoral capsule. SubAlloDerm capsule have fewer myofibroblast and lower TGF-beta expression than subpectoral capsule. CONCLUSION: Implant breast reconstruction using AlloDerm sling makes easy to get natural breast shape through satisfactory lower pole fullness, symmetric inframammary fold and implant positioning.

Reconstruction of the Bone Exposed Soft Tissue Defects in Lower Extremities using Artificial Dermis(AlloDerm(R))

PURPOSE: In extensive deep burn of the lower limb, due to less amount of soft tissue, bone is easily exposed. When it happens, natural healing or reconstruction with skin graft only is not easy. Local flap is difficult to succeed, because adjacent skins are burnt or skin grafted tissues. Muscle flap or free flap are also limited and has high failure rate due to deep tissue damage. The authors acquired good outcome by performing one-stage operation on bone exposed soft tissue defect with AlloDerm(R)(LifeCell, USA), an acellular dermal matrix producted from cadaveric skin. METHODS: We studied 14 bone exposed soft tissue defect patients from March 2002 to March 2009. Average age, sex, cause of burn, location of wound, duration of admission period, and postoperative complications were studied. We removed bony cortex with burring, until conforming pinpoint bone bleeding. Then rehydrated AlloDerm(R)(25/1000 inches, meshed type) was applicated on wound, and thin split thickness(6-8/1000 inches) skin graft was done at the immediately same operative time. RESULTS: Average age of patients was 53.6 years(25 years-80 years, SD=16.8), and 13 patients were male (male:female=13:1). Flame burn was the largest number. (Flame burn 6, electric burn 3, contact burn 4, and scalding burn 1). Tibia(8) was the most affected site(tibia 8, toe 4, malleolus 1, and metatarsal bone 1). Thin STSC with AlloDerm(R) took without additional surgery in 12 of 14 patients. Partial graft loss was shown in four cases. Two cases were small in size under 1x1cm, easily healed with simple dressing, and other two cases needed additional surgery. But in case of additional surgery, granulation tissue has easily formed, and simple patch graft on AlloDerm(R) was enough. Average duration of admission period of patients without additional surgery was 15 days(13-19 days). CONCLUSION: AlloDerm(R) and thin split thickness skin graft give us an advantage of short surgery time and less limitations in donor site than flap surgery. Postoperative scar is smaller compared to in conventional skin graft because of firmer restoration of dermal structure with AlloDerm(R). We propose that AlloDerm(R) and thin split thickness skin graft could be a solution to bone exposured soft tissue defects in extensive deep burned patients on lower extremities, especially when adjacent tissue cannot be used for flap due to extensive burn.

Immediate Breast Reconstruction Using Saline Implant: Extension of Pectoralis Major Muscle Coverage with AlloDerm(R)

PURPOSE: Using the implant for the breast reconstruction still remains the options, despite the breast reconstruction using autologous tissue is an ideal method. In this study, we used AlloDerm(R) to extend subpectoral pocket for covering implants to reduce implant related complications. METHODS: From January 2005 to June 2007, 18 breasts in 16 patients were reconstructed using implant and AlloDerm(R) immediately after mastectomy. Hospital records, database files, and clinical photographs were reviewed. A ten-point scale was used to evaluate the patient's satisfaction, with a range from 2(poor) to 10 (excellent). RESULTS: Mean age of the patients was 38.7 years at the time of operation. Mean weight of removed breast tissue was 287g. AlloDerm(R) was used to extend subpectoral coverage. Any systemic complication was not reported. Breast complication was developed in 4 cases. Implant removal or change was not experienced. CONCLUSION: Immediate breast reconstruction using Implant is useful methods for certain conditions, when donor tissue is insufficient and breast is non ptotic with round shape. In those cases, extension of muscle coverage using AlloDerm(R) could reduce complications and lead more acceptable results.

An experimental study and case analysis of acellular dermal matrix implantation for restoration of soft tissue defects

Effect of Avidin and Biotin in Attachment of Human Adipose Stem Cells to Micronized Acellular Dermal Matrix

PURPOSE: In tissue engineering, it is important that the scaffolds have high affinity with cells for making efficient use of cells. The authors studied the binding affinity of human adipose stem cells(ASCs) to micronized acellular dermal matrix(alloderm) using biotin and avidin linkages. METHODS: Human ASCs were harvested from adipose tissue obtained by abdominoplasty. ASCs(1x10(4), 5x10(4), 1x10(5), 5x10(5), 1x10(6), 5x10(6) cells) were attached to micronized alloderm(1mg) in three groups; 1) control group in which no ASCs and alloderm was treated; 2) serum group in which alloderm was exposed to fetal bovine serum; and 3) biotin group in which biotinylated cells were attached to biotinylated alloderm. The binding affinities were determined 1 day after making ASC-alloderm complexes. The proliferation rates were determined by XTT assays in 4, 7, 14, and 21 days and scanning electron microscopic examination was performed in 7 and 21 days after culture of ASC-alloderm complexes. RESULTS: The binding affinities of the biotin group were significantly increased in all cell concentrations. Maximum binding affinity was observed at 5x10(4)/mg of micronized dermal matrix in biotin group. The viabilities were lowest in biotin group in contrast to binding affinity, but the difference was not significant. SEM showed well attachment of cells to micronized dermal matrix in all groups. CONCLUSION: The use of avidin/biotin facilitated human ASCs attaching to micronized acellular dermal matrix. This attachment would not disturb adipose stem cells viabilities. The present study suggests that avidin/ biotin can be used as making efficient use of cells in adipose tissue engineering.

Acellular Dermal Allograft Transplantation in Patients with Scleromalacia After Pterygium Excision

PURPOSE: To report two cases of successful acellular dermal allograft transplantation for scleromalacia following pterygium excision. CASE SUMMARY: A 72-year-old female patient developed scleromalacia on the nasal side of the right eye, and a 79-year-old female patient developed scleromalacia with inflammation on the nasal side of the left eye. They had previous histories of pterigia removal on the sites of scleromalacia. Acellular dermal allograft (AlloDerm(R), Lifecell, NJ, USA) transplantations were done. After the operations, inflammation and pain ameliorated and the grafts survived without any particular complications. CONCLUSIONS: In treating scleromalacia, the transplantation of acellular dermal allografts produced relatively satisfactory results without undesirable problems commonly encountered when using conventional materials.

Usefulness of acellular dermal matrix graft on the tissue regeneration in rabbits

PURPOSE: The present study was aimed to examine the effect of acellular dermal matrix (AlloDerm(R)) grafted to the experimental tissue defect on tissue regeneration. MATERIALS AND METHODS: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and AlloDerm(R) graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, AlloDerm(R) graft, AlloDerm(R) graft impregnated with rhBMP-2, and AlloDerm(R) graft with rhTGF-beta(1). The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. RESULTS: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of AlloDerm(R) graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of AlloDerm(R) with no satisfactory results in the group of AlloDerm(R) graft. In the groups of the AlloDerm(R) graft with rhBMP-2 or rhTGF-beta(1), there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the AlloDerm(R) with regeneration features. However, the fibrous capsule also remained as in the group of AlloDerm(R) graft, which separated the AlloDerm(R) and the adjacent bone. CONCLUSIONS: These results suggest that AlloDerm(R) can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-beta(1).

Usefulness of acellular dermal matrix graft on the tissue regeneration in rabbits

PURPOSE: The present study was aimed to examine the effect of acellular dermal matrix (AlloDerm(R)) grafted to the experimental tissue defect on tissue regeneration. MATERIALS AND METHODS: Male albino rabbits were used. Soft tissue defects were prepared in the external abdominal oblique muscle. The animals were then divided into 3 groups by the graft material used: no graft, autogenous dermis graft, and AlloDerm(R) graft. The healing sites were histologically examined at weeks 4 and 8 after the graft. In another series, critical sized defects with 8-mm diameter were prepared in the right and left iliac bones. The animals were then divided into 5 groups: no graft, grafted with autogenous iliac bone, AlloDerm(R) graft, AlloDerm(R) graft impregnated with rhBMP-2, and AlloDerm(R) graft with rhTGF-beta(1). The healing sites of bone defect were investigated with radiologic densitometry and histological evaluation at weeks 4 and 8 after the graft. RESULTS: In the soft tissue defect, normal healing was seen in the group of no graft. Inflammatory cells and foreign body reactions were observed in the group of autogenous dermis graft, and the migration of fibroblasts and the formation of vessels into the collagen fibers were observed in the group of AlloDerm(R) graft. In the bone defect, the site of bone defect was healed by fibrous tissues in the group of no graft. The marked radiopacity and good regeneration were seen in the group of autogenous bone graft. There remained the traces of AlloDerm(R) with no satisfactory results in the group of AlloDerm(R) graft. In the groups of the AlloDerm(R) graft with rhBMP-2 or rhTGF-beta(1), there were numerous osteoblasts in the boundary of the adjacent bone which was closely approximated to the AlloDerm(R) with regeneration features. However, the fibrous capsule also remained as in the group of AlloDerm(R) graft, which separated the AlloDerm(R) and the adjacent bone. CONCLUSIONS: These results suggest that AlloDerm(R) can be useful to substitute the autogenous dermis in the soft tissue defect. However, it may not be useful as a bone graft material or a carrier, since the bone defect was not completely healed by the bony tissue, regardless of the presence of osteogenic factors like rhBMP-2 or rhTGF-beta(1).