Application of a Novel Meshed Human Reticular Acellular Dermal Matrix to Lower Extremity Wounds of Various Etiologies

Introduction: Resection and debridement of diabetic, and traumatic wounds often result in large soft tissue defects. These soft tissue defects can lead to infection, delayed healing, and other post-operative complications. A ready-to-use, off-the-shelf, pre-hydrated option, is meshed human reticular, acellular dermal matrix (HR-ADM) that provides a scaffold for native soft tissue restoration. The open architecture of the reticular layer supports cell infiltration and integration. The tissue form is intended for supplemental support to the underlying dermal matrix as the result of damage or naturally occurring defects. This current study is a 3-patient case series examining the use of meshed reticular dermal allograft for the treatment of diabetic foot and traumatic wound ulcerations after surgical intervention resulting in large soft tissue voids. Methods: Meshed HR-ADM was applied to partial to full thickness ulceration sites after thorough surgical debridement and secured in place. Negative pressure wound therapy (NPWT) was utilized when clinically appropriate, while bolster dressings were used when NPWT was not utilized. Weekly assessment and standard treatment protocols were followed until complete closure was achieved.Results: Robust granulation was observed in all three cases indicating the meshed HR-ADM is providing a solid dermal foundation for host cell infiltration and incorporation. Two of cases resulted in full closure. No adverse events were noted throughout the study. Discussion: Meshed HR-ADM provided a native dermal scaffold to support host cell infiltration and build healthy, organized and robust granulation tissue. While more research is needed, the observations demonstrate the reticular allograft matrix can support large post-surgical deficits by providing a solid dermal foundation and resulting in effective subsequent re-epithelialization. Appropriate use of such allograft results in faster wound closure and can decrease the likelihood of post-operative complications.