Aseptically Processed Placental and Dermal Tissue Matrices For Soft Tissue Reconstruction. A Review of 145 Cases

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 and dermal allografts are commonly used for resolving chronic wounds.   To date, little has been reported about the use of these tissue forms to enhance surgical outcomes..  We hypothesize that these tissue forms that have been utilized for chronic wound progression, may also be beneficial for patients who undergo surgical wound reconstruction.
We present a retrospective review of a series of 145 surgical reconstructive procedures over a 2 year period using aseptically processed placental and dermal grafts without terminal sterilization which is known to maintain the inherent growth factors and matrix proteins native to the tissue. All of which are known to support wound closure. 2,3  Specifically, we found that while surgical outcomes improved, it appears that even when there was a postsurgical wound complication, most were able to be reclosed and or healed secondarily.  All healed defects exhibited acceptable cosmesis and “normal” function, with 100% patient satisfaction.
The addition of aseptically processed allografts without terminal sterilization to reconstructive surgical flaps may improve outcomes. Maintaining inherent growth factors and matrix proteins are postulations while the exact mechanism is not known.  It is likely however, that the same mechanism that allows these allografts to optimize wound progression may also enhance surgical success.  We advocate the addition of aseptically processed allograft tissue matrices during surgical reconstruction of challenging chronic soft tissue defects to help optimize success, and help prepare for secondary healing if a complication does occur.
 
 

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1. Tran BNN, Chen AD, Kamali P, Singhal D., Lee BT, and Fukudome EY. National perioperative outcomes of flap coverage for pressure ulcers from 2005 to 2015 using American College of Surgeons National Surgical Quality Improvement Program. Archives of plastic surgery 2018 45(5), 418.
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.