Aseptically Processed Dehydrated Allograft Placental Membrane in Complex Surgical Reconstruction

Introduction: Surgical reconstruction of chronic wounds using soft tissue flaps is a routine approach to achieve closure. Due to the poor tissue quality, longstanding inflammation, bioburden and impaired blood supply, the success of flap closure is marred by reported complication rates of 25-58%.1

Placental allografts are commonly used in the management of chronic wounds, specifically to provide native matrix proteins and encourage wound progression. Surgical reconstruction may benefit from the addition of aseptically processed dehydrated allograft placental mini membrane to assist in optimizing the tissue for surgical healing.

Methods/Results: We present 6 cases of surgical reconstructive (lower extremity n=3, pressure ulcers n=2, chest wall n=1), where placental tissue was utilized. The dehydrated placental mini membrane was placed prior to wound closure, which included skin grafts, flap coverage and or complex closure. Negative pressure was applied postoperatively and continued for 7-10 days.

Surgical healing was achieved in 5 of 6 cases including 2 cases of limb salvage. The case of multiple pressure ulcers which resulted in dehiscence was surgically reclosed and ultimately healed successfully.

The aseptically processed placental tissue without terminal sterilization is known to maintain the inherent growth factors and native matrix proteins, which supports wound closure.2 We found that surgical outcomes were improved with a reduced incidence of post-operative complications well below the reported 25-58%.

Discussion: The addition of dehydrated allograft placental mini membrane without terminal sterilization to surgical reconstruction may improve both primary and secondary surgical outcomes. Maintaining inherent growth factors and matrix proteins are postulations while the exact mechanisms are not known.

In this case series, we observed improved surgical success with the addition of aseptically processed placental matrices intraoperatively. Additionally, in those cases where primary success was not achieved, the use of aseptically processed placental tissue assisted in the preparation for secondary closure and/or secondary healing.