AN EXPERIMENTAL STUDY AND CASE ANALYSIS OF ACELLULAR DERMAL MATRIX IMPLANTATION FOR RESTORATION OF SOFT TISSUE DEFECTS

연조직 결손부 회복을 위한 무세포성 진피 기질 이식에 대한 실험연구 및 증례분석

  • Ryu, Sun-Youl (Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University) ;
  • Ryu, Jae-Young (Department of Oral and Maxillofacial Surgery, School of Dentistry, Dental Science Research Institute, Chonnam National University)
  • 유선열 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소) ;
  • 류재영 (전남대학교 치의학전문대학원 구강악안면외과학교실, 전남대학교 치의학연구소)
  • Published : 2008.01.31

Abstract

Purpose: This study was aimed to examine the resorption rate, the healing pattern, and the response of the surrounding tissue after the graft of the acellular dermal matrix ($AlloDerm^{(R)}$) and the autogenous dermis, and to report the clinical result of the use of $AlloDerm^{(R)}$ in order to restore the soft tissue defects. Methods: Twenty mature rabbits, weighing about 3 ㎏, were used for the experimental study. The $10\times10$ mm-size autogenous dermis and the $AlloDerm^{(R)}$ were grafted to the space between the external abdominal oblique muscle and the fascia of the rabbits. And the $AlloDerm^{(R)}$ was grafted to the pocket between the skin and the underlying perichondrium of rabbit ear. The resorption rate of the grafted sites was calculated, and the tissue specimens were histologically examined at 1, 2, 4, and 8 weeks after the graft. The five patients with the cleft-lip nasal deformity and the one patient with the saddle nose deformity, who received the $AlloDerm^{(R)}$ graft to restore the facial soft tissue defects, were reviewed for the clinical study. Results: The resorption rate at 8 weeks after the graft was 21.5% for the autogenous dermis, and 16.0% $AlloDerm^{(R)}$. In microscopic examinations, the infiltration of the inflammatory cells and the epidermal inclusion cyst were observed in the autogenous dermis graft. However, the neovascularization and the progressive growth of the new fibroblasts were shown in the $AlloDerm^{(R)}$ graft. And the six patients, who received the $AlloDerm^{(R)}$ graft, demonstrated the good stability of the grafts and improved appearance. There were no remarkable complications such as inflammation, rejection, dislocation, and severe absorption in the clinical cases. Conclusion: These results suggest that $AlloDerm^{(R)}$ can be an useful graft material for restoration of soft tissue defects because of the good stability and the tissue response without the remarkable clinical complications.

Keywords

References

  1. Tobin HA, Karas ND : Lip augmentation using an AlloDerm graft. J Oral Maxillofac Surg 56 : 722, 1998 https://doi.org/10.1016/S0278-2391(98)90805-9
  2. Achauer BM, VanderKam VM, Celikoz B et al : Augmentation of facial soft-tissue defects with AlloDerm dermal graft. Ann Plast Surg 41 : 503, 1998 https://doi.org/10.1097/00000637-199811000-00009
  3. Menon NG, Rodriguez ED, Byrnes CK et al : Revascularization of human acellular dermis in full-thickness abdominal wall reconstruction in the rabbit model. Ann Plast Surg 50 : 523, 2003 https://doi.org/10.1097/01.SAP.0000044252.76804.6B
  4. Castor SA, To WC, Papay FA : Lip augmentation with AlloDerm acellular allogenic dermal graft and fat autograft: a comparison with autologous fat injection alone. Aesth Plast Surg 23 : 218, 1999 https://doi.org/10.1007/s002669900271
  5. Conley JJ, Clairmont AA : Dermal-fat-fascia grafts. Otolaryngol 86 : 641, 1978 https://doi.org/10.1177/01945998780860S420
  6. Ersek RA : Transplantation of purified autologous fat : a 3-year follow-up is disappointing. Plast Reconstr Surg 87 : 219, 1991 https://doi.org/10.1097/00006534-199102000-00001
  7. Shorr N, Perry JD, Goldberg RA et al : The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery: a preliminary report. Opthalmol Plast Reconstr Surg 16 : 223, 2000 https://doi.org/10.1097/00002341-200005000-00010
  8. Wainwright DJ, Madden M, Luterman A : Clinical evaluation of an acellular allograft dermal matrix in full thickness burns. Burn Care Rehabil 17 : 124, 1996 https://doi.org/10.1097/00004630-199603000-00006
  9. Millard DR : Cleft craft : The evolution of its surgery, Boston, Little Brown, 1976, p.551
  10. Nosan DK, Ochi JW, Davidson TM : Preservation of facial contour during parotidectomy. Otolaryngol Head Neck Surg 104 : 293, 1991 https://doi.org/10.1177/019459989110400302
  11. Sawhney CP, BanerjeeTN, Chakravarti RN : Behaviour of dermal fat transplants. Br J Plast Surg 22 : 169, 1969 https://doi.org/10.1016/S0007-1226(69)80061-5
  12. Ha H, Kim SK, Ryu SY : Tissue reaction in response to augmentation of soft tissue defects according to the dermis graft materials in rabbits. J Kor Oral Maxillofac Surg 33 : 114, 2007
  13. Wainwright DJ : Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns 21 : 243, 1995 https://doi.org/10.1016/0305-4179(95)93866-I
  14. Eppley BL : Experimental assessment of the revascularization of acellular human dermis for soft tissue augmentation. Plast Reconstr Surg 107 : 757, 2001 https://doi.org/10.1097/00006534-200103000-00016
  15. Sclafani AP, Romo T 3rd, Jacono AA et al : Evaluation of acellular dermal graft in sheet ($AlloDerm^{\circledR}$) and injectable (micronized $AlloDerm^{\circledR}$) forms for soft tissue augmentation. Clinical observations and histological analysis. Arch Facial Plast Surg 2 : 130, 2000 https://doi.org/10.1001/archfaci.2.2.130