Aseptically Processed Meshed Reticular Dermal Matrix For Soft Tissue Reconstruction for Necrotizing Fasciitis: Case Report

Necrotizing infection carries a high mortality.1 If the patient survives, they typically have undergone multiple surgical debridements to assist in clearing the infection and necrotic tissue.  As a result of excision of non-viable tissue, the patient is typically left with a significant tissue deficit. Cellular tissue products have become increasingly popular to assist with wound healing in chronic diabetic foot ulcers.2
Aseptically processed meshed reticular dermal matrix, SomaGen®(MTF Biologics) is unique in that it is an acellular dermal matrix that comes from the reticular dermis. It is the first meshed reticular dermal allograft.  The reticular dermal layer allow a more open network structure to better support cellular infiltration and tissue ingrowth.  Through aseptic processing without terminal sterilization, a sterility assurance level (SAL) - of 10-6 is achieved, while maintaining the integrity and function of the native matrix proteins.3,4
We present a case of necrotizing infection of the lower extremity. Following serial surgical debridements and negative pressure wound therapy with instillation and dwell time (NPWTi d*), the patient underwent meshed reticular allograft placement .  Following 6 weeks of continued NPWT, autologous grafting was performed.  At the time of skin grafting, the reticular dermal graft was completely incorporated into the host tissue with a reduction in wound depth with no bone or tendon exposed. 
Following autologous skin graft and NPWT the circumferential wound healed completely.  At  3 months the graft matured, the contour deficit was minimal. 
Aseptically processed meshed dermis derived from reticular dermis has properties that allow tissue integration and cellular infiltration. Patients who have wounds with an absolute tissue deficit may benefit from aseptically processed meshed allograft to help restore tissue and optimize the wound bed, prior to autologous skin grafting.
 
 
 

Trademarked Items (if applicable): SomaGen (MTF Biologics)

References (if applicable): REFERENCES

1. Golger A, Ching S, Goldsmith C, Penny R, Bain J: Mortality in Patients with Necrotizing Fasciitis. Plast. Reconstr. Surg 2006; 119(6):1804-1807.
2. DiDomenico LA, Orgill DP, Galiano RD, et al. Use of an aseptically processed, dehydrated human amnion and chorion membrane improves the likelihood and rate of healing in chronic diabetic foot ulcers: A prospective, randomized, multi-centre clinical trial in 80 patients. Int Wound J 2018; 15: 950-957.
3. Zelen CM, Orgill DP, Serena TE, et al. An aseptically processed, acellular, reticular, allogenic human dermis improves healing in diabetic foot ulcers: A prospective, randomized, controlled, multicenter follow-up trial. Int Wound J 2018: 1-9.
4. Phipps A, Vaynshteyn E, Kowalski JB, Ngo MD, Merritt K, Osborne J, Chnari E. Chemical sterilization of allograft dermal tissues. Cell Tissue Bank. 2017. Dec:18(4):573-584. doi: 10.1007/s10561-017-9647-0 Epub 2017 Aug 10