Addressing Complex Wounds with Aseptically Processed Pre-Meshed Human Reticular Dermal Allografts

Introduction: Complex wounds can require surgical reconstruction with grafts, flaps, and negative pressure wound therapy (NPWT). Aseptically processed human reticular acellular dermal matrices (HR-ADMs) provide the architecture for cell infiltration and have supported natural wound closure. Pre-meshed HR-ADMs can be expanded to cover large defects, facilitate drainage of exudate from the wound surface, and save OR time from meshing. This study examined how pre-meshed HR-ADMs aid in the natural rebuilding of complex wounds.

Background: Case 1 is a 46-year-old diabetic male, with gas gangrene on his right foot. Surgical intervention included primary amputation of the fourth and fifth toes with their respective metatarsal heads and debridement of nonviable tissue. Infection was decompressed along the plantar foot extending toward the plantar medial rear-foot. The plantar fascia was removed, debrided to healthy bleeding muscle, and packed with 0.25% sodium hypochlorite solution for three days. Subsequently, in the OR, pre-meshed HR-ADM was applied, secured with staples/nylon suture, dressed with oil emulsion dressing, and treated with NPWT, and the patient was off-loaded with a knee walker. Weekly vacuum changes were performed until graft incorporation (three weeks) with complete granulation observed at seven weeks.

Case 2 is a 56-year-old diabetic male with bilateral forefoot dry gangrene. A guillotine transmetatarsal amputation was performed due to compromised tissue perfusion and extensive soft-tissue necrosis after failing first and second ray resections. Post-amputation, pre-meshed HR-ADM was secured over the exposed metatarsal heads (to help expedite granulation), dressed with oil emulsion and NPWT. Eighty percent graft take was observed at week 1. Wound vacuum was changed weekly with debridement of necrotic tissue, culminating in substantial rebuild of the wound bed.

Results: These cases demonstrate the potential role of pre-meshed HR-ADMs for treating complicated wounds. By providing the natural inherent structure to support extensive granulation activities, pre-meshed HR-ADMs with NPWT aid tissue reconstruction in complex wounds.