Recubrimiento radicular de recesiones gingivales con matriz dérmica acelular / Root coverage of gingival recession with acellular dermal matrix

La recesión gingival es considerada como una deformidad o condición mucogingival, la Academia Americana de Periodontología, define a la recesión gingival como el desplazamiento del margen del tejido blando apical a la unión cemento-esmalte con la exposición de la superficie radicular. El tratamiento de las recesiones gingivales es un motivo de consulta común debido a razones estéticas, hipersensibilidad dentinaria, molestias durante el cepillado e incluso temor a la pérdida dentaria. Es una situación clínica común, 60% de la población humana tiene algún tipo de recesión gingival. Al realizar el examen clínico a paciente masculino de 55 años, se observó una recesión gingival tipo 1 (RT1) sin pérdida de inserción interproximal de la clasificación de Cairo. Se realizó el colgajo posicionado coronalmente (CPC) utilizando una matriz dérmica acelular (MDA) de origen humano OrACELL®. Se obtuvo resultado favorable en el recubrimiento de recesiones gingivales múltiples; considerándolos como una buena alternativa frente a los injertos gingivales autógenos. Concluyendo que, el uso de la matriz dérmica acelular para el tratamiento de la recesión gingival tipo 1 es una adecuada opción para el recubrimiento radicular. Se recomiendan más estudios a largo plazo para ver la estabilidad de los resultados obtenidos con la MDA (AU)

Gingival recession, considered a deformity or mucogingival condition, the American Academy of Periodontology, defines gingival recession as the exposure of the root surface resulting from migration of the gingival margin apical to the cementoenamel junction (CEJ). The treatment of gingival recessions is a common reason for consultation due to aesthetic reasons, dentin hypersensitivity, discomfort during brushing and even fear of tooth loss. It is a common clinical situation, 60% of the human population has some kind of gingival recession. Clinical examination of a 55-year-old male patient showed a type 1 gingival recession (RT1) without loss of interproximal insertion of the Cairo classification. Coronally advanced flap (CAF) was performed using an acellular dermal matrix (ADM) of human origin OrACELL®. Favorable results were obtained in the coating of multiple gingival recessions; considering them as a good alternative to autogenous gingival grafts. Concluding that, the use of the acellular dermal matrix for the treatment of gingival recession type 1, is a suitable option for root lining. Further long-term studies are recommended to see the elasticity of MDA outcomes (AU)

Tratamiento de recesiones gingivales tipo I y II de cairo: Reporte de caso

Introducción: Las recesiones gingivales, son defectos mucogingivales que ocurren con mayor frecuencia en adultos y pueden aumentar con la edad. Existe una exposición parcial de la superficie radicular y puede causar problemas estéticos, funcionales y periodontales. Reporte de caso: Paciente femenino de 51 años de edad, sistémicamente sana, diagnosticada con recesiones tipo I y II de Cairo, las cuales se trataron con técnicas de colgajo posicionado coronal, túnel y con uso de biomateriales como matriz dérmica acelular y proteínas derivadas del esmalte. Conclusión: La importancia de tomar en cuenta el diagnóstico de la recesión, así como las características del defecto y tejidos adyacentes determinarán el éxito en el tratamiento.

Introduction: Gingival recessions are mucogingival defects that occur more often in adults and may increase with age. There is a partial exposure of the tooth root which can create aesthetic, functional and periodontal problems. Case Report: 51 year-old female patient, systematically healthy, was diagnosed with Cairo type I and II recessions, which were treated with techniques such as: coronally advanced flap, tunnel and with the use of biomaterials like acellular dermal matrix and enamel matrix derivatives. Conclusion: The importance of taking into account the diagnosis of the recession, as well as the characteristics of the defect and adjacent tissues, will determine the success of the treatment.

Reconstrução do antebraço com matriz dérmica acelular após excisão de neurofibroma plexiforme gigante: relato de casos / Forearm reconstruction with acellular dermal matrix after giant plexiform neurofibroma excision: case reports

Introdução: O neurinoma plexiforme gigante é um neuroectoderma e uma doença hereditária. É um tumor cutâneo incomum associado à NF1, caracterizado como um tumor benigno da bainha do nervo periférico envolvendo múltiplos fascículos nervosos. Os objetivos da reconstrução da cobertura do antebraço são proteger as estruturas que vão até o punho e a mão e evitar cicatrizes que levem à perda de movimento. Tanto o antebraço quanto a mão desempenham papéis funcionais e sociais. O manejo bem-sucedido de feridas complexas é necessário para a reabilitação funcional geral desses pacientes. Relato do Caso: Paciente do sexo feminino, 31 anos, apresentou-se na divisão de cirurgia plástica com neurofibroma plexiforme gigante no antebraço direito. Após ressecção cuidadosa, todos os tendões anteriores do antebraço foram expostos. O defeito foi coberto com Pelnac T enxertável (espessura de 3mm e tamanho 12 X 24cm2), fixados com pontos monocryl 4-0. Após 10 dias, a matriz dérmica acelular foi removida e um enxerto de malha de pele de espessura parcial foi colocado. No dia 7, a matriz dérmica acelular apresentou bons sinais de ingestão. No dia 17, observamos uma sobrevida do enxerto de 95%. No seguimento de 3 meses, a reconstrução estava estável, sem defeitos de contorno, a mão apresentava amplitude de movimento completa e o paciente não apresentava problemas nas atividades diárias. Conclusões: A matriz dérmica acelular parece ser uma opção útil na cobertura de defeitos complexos no antebraço, permitindo menor morbidade e rápida recuperação funcional.

Introduction: Giant plexiform neurinoma is a neuroectoderm and inherited disease. It is an uncommon skin tumor associated with NF1, characterized as a benign peripheral nerve sheath tumor surrounding multiple nervous fascicles. The goals of forearm coverage reconstruction are to protect the structures running to the wrist and hand and prevent scarring that leads to movement loss. Both forearm and hand play functional and social roles. Successful management of complex wounds is necessary for the overall functional rehabilitation of these patients. Case Report: A 31-year-old woman presented at the plastic surgery division with a giant plexiform neurofibroma in the right forearm. After careful resection, all anterior forearm tendons were exposed. The defect was covered with graftable Pelnac T (thickness of 3mm and sizing 12 X 24cm2), fixed with 4-0 monocryl sutures. After 10 days, the acellular dermal matrix silicone layer was removed, and a split-thickness skin meshed graft was placed. On day 7, the acellular dermal matrix showed good signs of intake. On day 17, we observed a 95% graft survival. At the 3-month follow-up, reconstruction was stable without contouring defects, the hand had full range of motion, and the patient had no problems in daily activities. Conclusions: Acellular dermal matrix appears to be a useful option in covering complex defects in the forearm, allowing for less morbidity and rapid functional recovery.

Reconstrucción mamaria diferida con expansor-implante y matriz dérmica autóloga. Una alternativa terapéutica aplicable en tejidos no irradiados. / Delayed breast reconstruction with expander-implant and autologous dermal matrix. An alternative applicable therapeutic in non irradiated tissues.

INTRODUCCIÓN Y OBJETIVO: la reconstrucción mamaria diferida o post mastectomía tiene una importancia trascendental en la vida de la mujer así también como parte del tratamiento integral y multidisciplinario del cáncer mamario, ya que tamaña agresión impacta en la autoestima y funcionalidad social en aquellas mujeres que por algún motivo no fueron sometidas a reconstrucción inmediata. El objetivo es describir a través de la técnica expansor-implante, matriz dérmica autóloga, injerto de grasa y reconstrucción del complejo areola pezón con tejidos autólogos, los resultados alcanzados en pacientes mastectomizadas y reconstruidas de manera diferida. MATERIAL Y MÉTODO: es un estudio retrospectivo, longitudinal, observacional y descriptivo de una serie pequeña de 5 pacientes privadas mastectomizadas no irradiadas que no fueron sometidas por algún motivo a reconstrucción inmediata en otros centros médicos y que acudieron al consultorio privado derivadas por médicos cirujanos mastólogos-oncólogos para ser sometidas en forma diferida a reconstrucción con expansor implante en una secuencia técnica de 3 tiempos quirúrgicos en un periodo comprendido entre abril del 2015 y octubre del 2020. RESULTADOS: la reconstrucción diferida habitualmente la realizamos con expansor-implante y optamos por la utilización de colgajos autólogos siempre cuando se hubiera irradiado la mama enferma. En 4 de 5 pacientes realizamos la reconstrucción del complejo areola pezón (CAP), 3 pacientes fueron de reconstrucción unilateral y 2 de bilateral, en 2 mujeres ocupamos prótesis de doble lumen tipo anatómicos y en 3 mujeres expansor con puerto a distancia, utilizando en 2 pacientes, prótesis de forma redonda y en un implante expansor anatómico. Presentamos un caso de deflación del implante a los 3 años post reconstrucción no reportamos casos de necrosis grasa, ni cuadros infecciosos, no presentamos casos de contractura capsular y reportamos un solo caso de seroma tardío de origen traumático en una paciente de reconstrucción unilateral a los 7 meses post implante. CONCLUSIÓN: la técnica reconstructiva diferida de expansor-implante, matriz dérmica autóloga, y tejidos propios para la reconstrucción del CAP, representan una buena opción terapéutica de baja morbilidad en pacientes que no han sido sometidas a irradiación post mastectomía. Creemos que a nivel nacional aún faltan políticas en salud y conductas que beneficien a las mujeres con cáncer mamario en el camino largo del tratamiento integral de la enfermedad hasta la reconstrucción mamaria y su re inserción con funcionalidad social, laboral y emocional, para unificar criterios y protocolos entre servicios públicos, privados, ministerio de salud, secretarias regionales de salud y sociedades científicas de Mastologia y Cirugía Plástica apoyando a los pocos equipos en reconstrucción mamaria , optimizando protocolos médicos que beneficien a las pacientes enfermos.

INTRODUCTION AND OBJECTIVE: delayed breast reconstruction or post mastectomy has a transcendental importance in women ́s life as well as part of the comprehensive and multidisciplinary treatment of breast cancer. Such aggression impacts on self-esteem and social functionality in women who for some reason were not undergoing immediate reconstruction. The objective is to describe the results achieved in mastectomized patients, through the expander-implant technique, autologous dermal matrix, fat graft and reconstruction of the nipple areola complex (NAC) with autologous tissues MATERIAL AND METHOD: it is a retrospective, longitudinal, observational and descriptive study of a small group of 5 non-irradiated mastectomized private patients who were not subjected to an immediate reconstruction at other medical centers. They came to the private practice referred by other mastologists-oncologists medical surgeons to be submitted to a delayed breast reconstruction with expander prosthesis in a 3 surgical times technique between April 2015 and October 2018. RESULTS: the delayed breast reconstruction is usually performed with expander prosthesis and for those injured breasts that had been irradiated, we use autologous flaps. In 4 out of 5 patients we performed the reconstruction of the NAC, 3 were submitted to unilateral reconstruction and 2 were bilateral, 2 women had anatomical double lumen prosthesis, 3 had expander implant with remote port at which 2 were round and one anatomical. We presented only one case of deflation 3 years later after reconstruction. We didn ́t report cases of fat necrosis nor infectious symptoms. We didn ́t have any case of capsular contracture but only a single case of late seroma after 7 months' post implant in a patient with unilateral reconstruction due to a traumatic incident. CONCLUSION: the delayed breast reconstructive technique with expander-implant, uses of autologous dermal matrix or own tissues for reconstructing the NAC, represents a good therapeutic option of low morbidity to patients who have not undergone post-mastectomy irradiation. We briefly believe that at a National level there is a lack of health policies and therapeutic behaviors that could benefit women with breast cancer on this long path from a complete treatment of this disease to breast reconstruction and its social, labor and emotional reintegration, to unify criteria and protocols between public services, private services, ministry of health, regional secretaries of health and scientific societies such as Mastology and Plastic Surgery to support the few teams in breast reconstruction and optimize medical protocols to benefits the sick patient.

Repair experience of skin necrosis after penile thickening with acellular dermal matrix patch / 中华泌尿外科杂志

A serious complication of penile girth enhancement with acellular dermal matrix(ADM) patch is large area penile skin necrosis. Since the penile skin has characteristics such as thin, elasticity, pliability, and durability to withstand erection and friction, the repair surgery is often difficult to achieve good results. Furthermore, the implantation of ADM patch increases the difficulty of surgery. From March 2014 to August 2019, a total of 13 patients with skin necrosis after penile girth enhancement with ADM patch were treated in our center.The debridement and change dressing, according to the condition of the necrotic skin of penis, were performed in all patients. 7 patients used the repairing method of scrotal skin flap via one side scrotal artery, 6 patients used the repairing method of full thickness skin graft. The penile function was not affected with 6 to 12 months′ follow-up after surgery and the curative effect was satisfactory.

The comparative study of lingual mucosal graft combined with buccal mucosal graft and ADM urethroplasty for failed hypospadias repair / 中华泌尿外科杂志

Objective:To compare the outcomes of combined lingual mucosal graft with buccal mucosal graft urethroplasty and combined lingual mucosal graft with ADM (acellular dermal matrix) urethroplasty for the treatment of repair failed hypospadias.Methods:From February 2017 to February 2019, 26 patients with failed hypospadias repairs were treated with combined lingual mucosal graft with buccal mucosal graft urethroplasty (14 cases in Group A), and combined lingual mucosal graft with ADM urethroplasty (12 cases in Group B). The mean age of Group A was (29.5±1.2) years (range 18.0-41.0 years), and (26.5±0.8) years (range 20.0-38.0 years) in Group B. The previous operation times was mean (3.6±0.7)(range 2-5 times) and (4.6±0.8)(range 3-5 times) in Group A and Group B respectively. Operation method: All patients were nasally intubated, the remaining curvature was corrected, the fibrous tissue or scar was removed, and the defected urethra was measured. In Group A, the lingual mucosa was spread and fixed to the corpora cavernosa over the midline as the urethral plate, the buccal mucosa was covered the lingual mucosa as ventral urethra, both the mucosa lateral edges was sutured. In Group B, the lingual mucosa was harvested and fixed to the corpora cavernosa the same as in Group A, the ADM was made appropriate length and width, covered and sutured with the lingual mucosa. The lingual mucosa was harvested mean (5.0±0.2)cm(range 4-6cm)long, mean (1.2±0.2)cm (range 1.0-1.5cm)wide and mean (5.0±0.2)cm(range 5-6cm)long, mean (1.2±0.2)cm (range 1.0-1.5cm)wide in Group A and Group B respectively( P<0.05). In Group A, the buccal mucosa was harvested mean (4.1±0.2)cm(range 3.5-5.5cm)long, mean (1.2±0.2)cm wide. Criteria for successful repair of hypospadias were set as: ①The appearance of the penis is nearly normal; ②The penis curvature was corrected; ③Urethra orifice in normal position; ④Urine flow line is normal. The outcomes of the two groups were analyzed and compared, statistical analysis was done using SPSS 18.0 software. Results:The mean follow-up time was (16.3±1.6)(8-24) months. The age, number of preoperative surgeries, number of previous oral mucous membranes, and length of urethral defects were no statistically significant differences between the two groups in A and B( P>0.05). The length of oral mucosa was harvested during the operation between group A and Group B were statistically significant differences( P<0.05). The incidence of oral complications in group A and B: Oral pain 7/14, 1/12; The feeling of tension in mouth 8/14, 1/12; The numbness in the oral 8/14, 1/12, A and Group B were statistically significant differences( P<0.05). The incidence of urethral complications in group A and Group B: the urethra fistula 1/14, 4/12; the urethral stricture 2/14, 6/12, there were statistically significant differences between the two groups ( P<0.05). Penile curvature 2/14, 1/12, ( P>0.05). The success rate was 12/14 and 5/12 in Group A and B respectively, with statistical difference( P<0.05). Conclusions:Combined lingual mucosal graft with buccal mucosal graft urethroplasty could be a good choice for repeated failed hypospadias repairs. Combined lingual mucosal graft with ADM urethroplasty has many complications and less success, should be performed in caution.

Comparison of platelet rich fibrin and acellular dermal matrix in repairing rabbits′ oral mucosal defects / 口腔疾病防治

Objective@# To investigate the effects of platelet-rich fibrin (PRF) and acellular dermal matrix (ADM) on the repair of oral mucosal defects and to provide the basis for soft tissue growth in oral implant operations.@*Methods@#Thirty-six healthy male Japanese big ear rabbits were randomly divided into the PRF group, ADM group, Autograft group (autologous connective tissue transplantation group) and Control group (blank control group); each group contained nine rabbits. Between the midline and the hard palate maxillary incisors, in an 8-mm location preparation and a 10-mm standard mucosa defect, the ADM group, PRF and Autograft group were implanted with ADM, autologous PRF and autologous cornification mucosa, respectively, whereas the control group had wound gauze compression processing at 7, 14, and 21 days to determine the wound healing rate in the area selected by HE staining. The inflammatory grade and average epithelial thickness were observed, and the results were statistically analyzed.@*Results @#Compared with the control group, the PRF, ADM and Autograft groups had significantly advanced wound healing (P < 0.05). The wound healing degree in the PRF group was similar to that of the ADM group at all time points (P > 0.05). The wound healing degree in the PRF and ADM groups was lower than that of the Autograft group at each time point (P < 0.05). HE staining results showed that compared with the control group, the levels of inflammation in the PRF group, ADM group and Autograft group were reduced, and the difference was statistically significant (P < 0.05). Nevertheless, there was no significant difference between the PRF, ADM and Autograft groups (P > 0.05). The epithelial thickness in the ADM group was similar to that in the Autograft group (P > 0.05). The epithelial thickness in the ADM group was higher than that in the PRF group at 7 d and 14 d (P < 0.05), but there was no significant difference at 21 d (P > 0.05).@*Conclusion @#PRF and ADM have similar healing effects in repairing oral mucosa defects, and they can be used as soft tissue augmentation materials instead of connective tissue transplantation.

Acellular dermal matrix in skin wound healing in rabbits - histological and histomorphometric analyses

OBJECTIVES: To analyze the histology and histomorphometry of healing associated with acellular dermal matrix in skin wounds in rabbits. METHODS: Twelve male rabbits were divided into two groups: the control group (CG) and the matrix group (MG). Three skin wounds with a total area of 20 × 20 mm were created on the dorsal region of each animal. Photographic records of the lesions taken over a 21-day period and use of the ImageJ program allowed calculation of the wound contraction rate. The lesions were biopsied on days 3, 14 and 21 for histomorphometric analysis to define the thicknesses of the dermis and epidermis (hematoxylin-eosin) and calculate the densities of type I and type III collagen (picrosirius). RESULTS: No significant difference in the healing rate was found between the groups (p>0.05). The MG presented greater epidermal thickness on day 3 (p<0.05) and on days 14 and 21 (p<0.001). The MG presented greater dermal thickness throughout the study period (p<0.05). The type I collagen density was higher in the MG throughout the study period (p<0.05), and the type III collagen density was higher in the MG on days 3 and 14 (p<0.05) and on day 21 (p<0.001). CONCLUSION: The use of acellular dermal matrix increased the thickness of the dermal and epidermal layers and the amount of type I and III collagen during skin wound healing and did not alter the rate of wound contraction.

Reconstrucción de herida compleja en mano con hyalomatrix® / Reconstruction of complex wound in hand with hyalomatrix®

El manejo de heridas complejas con compromiso de la dermis en la mano es un desafío para los cirujanos; el uso de sustitutos dérmicos en la actualidad se presenta como una posibilidad de obtener una cicatriz estética y funcionalmente adecuada. Presentamos un caso manejado en nuestro centro con excelentes resultados funcionales y estéticos.

The management of complex wounds with involvement of the dermis in the hand is a challenge for surgeons; The use of dermal substitutes at present is presented as a possibility of obtaining an aesthetically and functionally adequate scar. We present a case handled in our center with excellent functional and aesthetic results.

Use of dermal matrices to change gingival phenotypes

ABSTRACT: A variety of periodontal plastic surgery techniques have been proposed to correct aesthetic and functional problems of periodontal tissues. The most common procedure uses the connective tissue graft from the palate. However, patient discomfort and the limited quantity of palatal tissue results in many cases where the surgeon uses connective tissue substitutes. In this case report, we describe the use of a human dermal matrix for gingival volume augmentation in the lower incisors with a novel modified VISTA technique stabilizing the flap with sutures and cyanoacrylates, avoiding comorbidity of a second surgical site. The follow up at 6 months showed an increase in gingival thickness and a reduction in recessions length.

Bone marrow mesenchymal stem cells combined with acellular dermal matrix repair beagle dog articular cartilage defects / 中国组织工程研究

BACKGROUND: Dermis-derived extracellular matrix, as a cartilage repair scaffold, provides a space for the growth of cartilage tissue, and promotes cell adhesion and proliferation. Bone marrow mesenchymal stem cells have the potential to differentiate into chondrocytes. Both of them used alone have disadvantages. OBJECTIVE: To evaluate the feasibility of bone marrow mesenchymal stem cells combined with calf acellular dermal matrix to repair beagle dog articular cartilage defects. METHODS: Beagle dog bone marrow blood was extracted from Beagle dogs. Bone marrow mesenchymal stem cells were obtained by density gradient centrifugation and passaged. Acellular dermal matrix was prepared from the dorsal dermis of neonatal calves by ultrasonic oscillation, freeze-drying and pepsin. 0. 2 mL of cell suspension was added to the surface of acellular dermal matrix until covered, then which was placed in a 5% CO2 incubator at 37 °C for 48 hours. Twelve adult beagle dogs were used to establish knee joint cartilage defect models, and then randomized into three groups: In the acellular dermal matrix combined with bone marrow mesenchymal stem cells group (combination group), cartilage defects were repaired with acellular dermal matrix combined with bone marrow mesenchymal stem cells. In the single acellular dermal matrix group, cartilage defects were repaired with acellular dermal matrix. The model control group received no treatment. At 12 weeks after surgery, the right knee joints were observed by stereomicroscope, hematoxylin-eosin staining and type II collagen immunohistochemical staining. RESULTS AND CONCLUSION: (1) Scanning electron microscopy showed that bone marrow mesenchymal stem cells adhered to and grew well in the acellular dermal matrix. (2) Hematoxylin-eosin staining revealed that the repaired surface in the combination group was slightly lower than that of the surrounding normal tissues, and the repaired tissues integrated well with the surrounding cartilages. The defects in the single acellular dermal matrix group were filled with fibrous tissues. Few surrounding tissues of defect were repaired in the model control group. (3) Type II collagen immunohistochemical staining showed that in the combination group, articular cartilage defects were filled with chondrocyte-like tissues. In the single acellular dermal matrix group, the defect was filled with fibrous tissues. No tissue was found in the model control group. (4) These results indicate that the new calf acellular dermal matrix has good biocompatibility and can promote the proliferation of bone marrow mesenchymal stem cells. Autologous bone marrow mesenchymal stem cells combined with acellular dermal matrix can effectively repair beagle dog knee joint cartilage defects.

National expert consensus on the application of natural dermal matrix in wound repair (2020 version) / 中华烧伤杂志

Natural dermal matrix has good biocompatibility and can serve as " biological template" in wound repair. According to the source of material, natural dermal matrix can be divided into acellular dermal matrix (ADM), denatured dermal matrix, and scar dermal matrix. ADM is a biological material prepared by removing cellular components from the skin and retaining extracellular matrix (ECM) of the dermis. ADM possesses abundant natural biological information, low immunogenicity, and excellent regenerative capacity, which has greatly promoted the development of wound healing specialty as dermal substitute. Denatured dermis matrix is a layer of dermal tissue made by superficial tangential excision or dermabrasion on deeply burned wounds. The retained denatured dermis can recover gradually after transplantation of autologous skin on its surface, with similar structure, morphology, and biomechanics to healthy dermis. Scar dermal matrix is a kind of dermal scaffold made of autologous split-thickness scar tissue, possessing the characteristics of high survival rate, good texture, and slight scar reaction. Scar dermal matrix can effectively reduce secondary damage to the donor site when repairing scar contracture deformity. Based on the research progress at home and abroad and the opinions of domestic experts, this paper summarizes the indications, application methods, contraindications, and considerations of different types of natural dermal matrix in application of wound repair.

Decision regret analysis among Chinese patients receiving penile girth enhancement with acellular dermal matrix / 北京大学学报(医学版)

OBJECTIVE@#To evaluate decision regret among patients receiving penile girth enhancement with acellular dermal matrix (PGE with ADM) and to investigate the potential indicators for decisional regret so as to facilitate the decision-making process for this special group.@*METHODS@#In the study, 78 patients receiving PGE with ADM from Jun. 2016 to Jan. 2019 at Peking University People's Hospital and cooperative hospitals were eligible. Penile girth was taken by only one surgeon 1 week before surgery. Hospital anxiety and depression scale (HAD), international index of erectile function (IIEF) and a 10 cm long visual analogue scale named visualized penile image (VPI) were applied to measure psychological burden, erectile function and satisfaction with penile image respectively at the same time. All the patients were followed up for 3 months. Decision regret scale (DRS) was adopted for measuring decisional regret. Multivariate analysis of variance was applied to investigate the potential indicators for regret. Data analysis process was conducted with SPSS (version 24.0; SPSS, Chicago, IL, USA).@*RESULTS@#Mean penile girth recorded before intervention was (8.29±0.30) cm and increased to (9.46±0.29) cm post surgery (t=76.28, P < 0.01). As for both subscales of HAD measuring psychological burden, a signi-ficant reduction in the mean score was seen, that is, 2.8±1.3 (t=19.28, P < 0.05) for anxiety and 3.0±1.2 (t=20.67, P < 0.05) for depression, respectively. The average score of VPI increased by 3.7±1.1 (t=30.63, P < 0.05). There was no significant change in the average score of IIEF measuring erectile satisfaction (t=1.60, P=0.11). Twenty-nine (38.2%) patients expressed regret to some degree, and the mean DRS score was 23.4±14.8. The scores of DRS correlated negatively with scores of visualized penis image (r=-0.348, P < 0.01), and positively with scores of anxiety (r=0.760, P < 0.01) and depression subscale (r=0.471, P < 0.01). The scores of DRS was irrelevant to those of IIEF (r=0.02, P=0.867). The patients with high annual income (> 120 000 yuan) and education level above undergraduate were more prone to experience decision regret after intervention (P < 0.01).@*CONCLUSION@#PGE with ADM did augment penile girth and lower psychological burden, the regret rate of which was acceptably low among the patients. High income and good education might indicate more post-operative regret. Additional decision-making aids should be offered to patients with high income and education level above high school.

Tratamiento Quirúrgico de la Recesión en el Sector Anterior a través de la Técnica de Túnel Modificada Utilizando Matriz Dérmica Acelular / Surgical Treatment of the Recession in the Anterior Sector through the Modified Tunnel Technique Using the Acellular Dermal Matrix

RESUMEN: Objetivo: El propósito del reporte de caso fue evaluar la cobertura radicular (CR) en el sector anterior luego de haber realizado la técnica de túnel modificada utilizando Matriz Dérmica Acelular (MDA). Consideraciones clínicas: La literatura ha descrito el uso de la técnica de túnel desde hace varias décadas y en los últimos años se ha perfeccionado con desplazamiento del tejido gingival hacia coronal simultáneo con el uso de MDA con el fin de lograr mejores resultados. Aunque en situaciones clínicas de cobertura de recesión gingival (RG) es discutible qué técnica puede ser más efectiva y existen diferentes alternativas, la técnica de túnel más colgajo desplazado coronal utilizando MDA es una línea de investigación prometedora y todavía no está concluída por tanto sería interesante profundizar al respecto. Conclusión: El caso clínico presenta el seguimiento de un paciente con recesión tipo 1 (RT1), que fue operado utilizando MDA y la técnica de túnel modificada demostrando que puede ser efectiva en la cobertura total de la recesión con resultados estéticos sostenibles en un período de 24 meses.

ABSTRACT: Objective: The purpose of the case report was to evaluate the radicular coverage (RC) in the upper anterior sector after having performed the modified tunnel technique using the Acellular Dermal Matrix (ADM). Clinical considerations: The literature has described the use of the tunnel technique for several decades and in recent years has been perfected with displacement of the gingival tissue to coronal with the use of ADM to achieve better results. Although in clinical situations of gingival recession (GR) coverage it is questionable which technique can be more effective and there are different alternatives, the tunneling technique plus coronal displacement flap using ADM is a promising line of research and is not yet concluded so it would be interesting to deepen in this regard. Conclusion: The clinical case presents the follow-up of a patient with recession type 1 (RT1) who was operated using ADM and the modified tunnel technique demonstrating that it can be effective in the total coverage of the recession with sustainable aesthetic results in a period of 24 months.

Prepectoral breast reconstruction / 영남의대학술지

Implant-based breast reconstruction is the most commonly used reconstruction technique after mastectomy. This is because skin-sparing mastectomy has become possible with advancements in oncology. In addition, the development of breast implants and the advent of acellular dermal matrices have reduced postoperative complications and resulted in superior cosmetic results. The most frequently performed surgical breast reconstruction procedure for the past 20 years was the insertion of an implant under the pectoralis major muscle by means of the dual plane approach. However, some patients suffered from pain and animation deformity caused by muscle manipulation. Recently, a prepectoral approach has been used to solve the above problems in select patients, and the results are similar to subpectoral results. However, this technique is not always chosen due to the number of considerations for successful surgery. In this article, we will discuss the emergence of prepectoral breast reconstruction, indications and contraindications, surgical procedures, and outcomes.

Use of Acellular Allogenic Dermal Matrix in Soft Palate Reconstruction after Excision the Pleomorphic Adenoma / 대한두경부종양학회지

Recent studies have reported on the reconstruction of oral mucosal defects using acellular dermal matrix (ADM). This case report describes the reconstruction of a soft-palate mucosal defect using ADM. A 43-year-old man developed a 2.5 cm × 3 cm soft-palate mucosal defect after the removal of a lump on the soft palate andreconstructed the defect using ADM without further complications. Reconstruction of the soft palate with ADM could be more convenient than traditional methods including primary closure, skin graft, and local or free flap without complications.

Changes of skin mechanical properties and reuse of denatured dermis after deep second-degree burn in rats / 上海交通大学学报（医学版）

Objective • To investigate the changes of skin mechanical properties after deep second-degree burn, and study the feasibility of composite transplantation by using denatured dermal acellular matrix. Methods • The deep second-degree burn models in SD rats were constructed, and then the full skins were harvested after 3 h and 3 d, respectively, to compare the skin modulus of elasticity and ultimate load with normal skins. In addition, the structural differences of the dermal matrix were also compared. The composite transplantations were conducted by using the normal or denatured dermal acellular matrix, and then the general and histological structures of living skin grafts were observed. Results • The moduli of elasticity of the normal skins and the skins 3 h and 3 d after burn in SD rats were (8.7±6.4) MPa, (7.2±2.7) MPa and (2.7±0.3) MPa, respectively. The ultimate loads were (107.1±41.7) N, (81.5±10.8) N and (42.2±7.0) N, respectively. Both indexes were significantly reduced in the skins 3 d after burn compared to the normal ones (P<0.05). In the acellular matrix of denatured dermis 3 h after burn, the pore structure was still similar to that of normal one, and the appearance and histological structure after healing from composite transplantation were similar to those of the control group. Conclusion • The early denatured skin tissue after deep second-degree burn maintains the similar mechanical properties and histological structure to the normal skin, which is a potential source of acellular dermal matrix for composite transplantation.

Preparation of five kinds of acellular fish skin matrices and in vitro toxicity analysis / 第二军医大学学报

Objective To explore the biological safety and compatibility of five kinds of acellular fish skin matrices, and to screen the materials meeting the criteria of biocompatibility. Methods Acellular fish skin matrices were prepared through decolorization, degreasing, decellularization and cross-linking using five kinds of fish skins leather jacket fish (Thamnaconus septentrionalis), black fish (Channa argus), eel (Anguillidae), carp (Cyprinus carpio) and silver crap (Hypophthalmichthys molitrix). According to the national standard (GB/T 16886.5-2017), different concentrations (10 g/L and 100 g/L) of extracts of acellular fish skin matrices were prepared, and the CCK-8 assay was used to detect the in vitro toxicity of extracts of acellular fish skin matrices to human bone marrow-derived mesenchymal stem cells. The surface structures of different collagen membranes were observed under scanning electron microscopy. The H-E and Masson staining were used to observe whether the fish skin matrix materials were completely acellular. The human bone marrow-derived mesenchymal stem cells were cultured with the medium containing standard concentration of 100 g/L acellular fish skin matrix material extracts. The blood compatibility of the meterial was tested by hemolysis test. Live/Dead, TUNEL and flow cytometry were used to detect the cell survival and apoptosis levels. Results CCK-8 assay showed that the viability indexes of the cells co-cultured with the leather jacket fish and black fish skin acellular matrix material extracts were both 70% at the concentration of 10 g/L, and the other three materials were all 70%. At the concentration of 100 g/L, the viability index of the cells co-cultured with the leather jacket fish skin acellular matrix material extracts was 70%, and that with the black fish was 70%. Scanning electron microscopy showed that the leather jacket fish skin acellular matrix materials had porous and compact structure inside, and black fish skin acellular matrix materials had smooth structure inside. The H-E staining and Masson staining showed that leather jacket fish and black fish skin acellular matrix materials were both acellular collagen fibers. The hemolysis rates (the national standard ≤5%) of leather jacket fish and black fish skin acellular matrix material extracts were (1.23±0.43)% and (6.35±0.47)%, respectively. Human bone marrow-derived mesenchymal stem cells survived well in the culture medium containing extracts of leather jacket fish skin acellular matrix material, but most cells died or apoptozed in the culture medium containing extracts of Black fish skin acellular matrix material. Conclusion The leather jacket fish decellularized skin matrix material has better biosafety and biocompatibility, and has the potential to be a scaffold material for tissue engineering.

Split-thickness scalp and allogenic acellular dermal matrix in repairing deep wounds of hands in patients with extremely extensive burns / 中华烧伤杂志

Objective@#To explore the clinical effects of split-thickness scalp and allogenic acellular dermal matrix (ADM) in repairing deep wounds of hands in patients with extremely extensive burns.@*Methods@#Six patients with extremely extensive burns complicated by deep burn in hands were admitted to our department from December 2014 to December 2017, including 4 males and 2 females, aged 21 to 58 years. Their total burn areas were from 85% to 95% total body surface area (TBSA), and the sum of deep-partial thickness and full-thickness wounds was larger than 50% TBSA. Under general anesthesia, deep wounds of 10 dorsal hands were repaired by combined transplantation of split-thickness scalp and allogenic ADM in 4 to 6 weeks after injury. The skin grafting range was beyond the metacarpophalangeal joint, including partial dorsal digital deep wounds. Survival of skin grafts on dorsal hands, follow-up of hand shape and functional recovery were observed and recorded.@*Results@#Six patients were successfully treated. There was no infection on the dorsal deep wounds of 10 hands after surgery, and the grafts survived well. During follow-up of 1 to 2 years after operation, there were no recurrent tension blisters or dorsal extension deformity of the metacarpophalangeal joints in 10 hands, the shape and function of hands recovered well, and hand Carroll scores were from 90 to 99 points, with functional levels of Ⅴ and Ⅵ.@*Conclusions@#The combined transplantation of split-thickness scalp and allogenic ADM is a good method for repairing deep hand wounds in patients with extremely extensive burns, which can alleviate the cicatrix hyperplasia and contracture of healed hand wounds, and improve the shape and function of hands.

Application status of commonly used patches in breast reconstruction / 中国肿瘤临床

Breast reconstruction is an essential part in the comprehensive management of breast cancer. The clinical application of patches (e.g., acellular dermal matrix, ADM) is the most impactful innovation in implant breast reconstruction in recent years. The wide application of patches in implant breast reconstruction promotes the development of immediate prosthetic reconstruction, im-proves the aesthetic outcomes of reconstructed breasts, and avoids additional donor tissue damage caused by autologous flap breast reconstruction. At present, patches used in breast reconstruction are mainly ADMs, bovine pericardial patches, and TiLOOP, which are widely used because of their good histocompatibility and tissue defect repair ability. This article reviews the applications and research statuses of these patches.