Acellular dermal matrices in reconstructive surgery; history, current implications and future perspectives for surgeons

Table 1 Some of the commonly available acellular dermal matrices

ADM	Source	Processor
Alloderm®	Human	LifeCell Corp., Bridgewater, NJ, United States
Allomax®	Human	CR Bard/Davol Inc., Cranston, RI, United States
DermACELL®	Human	LifeNet Health Inc., Virginia Beach, VA, United States
NeoForm®	Human	Mentor, United States
Ethicon®	Human	Ethicon Inc., Somerville, NJ, United States
MatriDerm®	Bovine	Dr Suwelack AG, Billerbeck, Germany
IntegraTM	Bovine	Life Sciences, Princeton, NJ, United States
Renoskin®	Bovine	Perouse Plastie, France
PermacolTM	Porcine	Medtronic, Minneapolis, MN, United States
Strattice®	Porcine	Allergan, Madison, NJ, United States
CollaMendTM	Porcine	CR Bard/Davol Inc., Cranston, RI, United States

Table 2 Clinical evidence examples of the utilization of acellular dermal matrix in burn

Ref.	Year	Title	Note
Li et al[45]	2015	Human acellular dermal matrix allograft: A randomized, controlled human trial for the long-term evaluation of patients with extensive burns	This randomized controlled clinical trial of human acellular dermal matrix (ADM) showed that the composite graft of human ADM with thinner split-thickness skin graft could provide acceptable esthetic outcomes, good functional recovery, and less scar formation at the donor site
Heimbach et al[33]	2003	Multicenter postapproval clinical trial of Integra dermal regeneration template for burn treatment	Integra® has been found useful in postburn reconstructive procedures both for pediatric and adult patients, affording improved cosmetic results. It clearly provides a valuable, effective and safe clinical treatment modality for dealing with the difficult clinical management challenge posed by the extensively burned patient
Nguyen et al[32]	2010	An objective long-term evaluation of Integra (a dermal skin substitute) and split thickness skin grafts, in acute burns and reconstructive surgery	Authors conclude that when objectively measured ADM treated sites correlate well with subject’s normal skin elasticity whilst no correlation was seen with the subject’s skin grafted sites
Guo et al[35]	2016	Use of porcine acellular dermal matrix following early dermabrasion reduces length of stay in extensive deep dermal burns	In this retrospective study authors conclude that early dermabrasion combined with porcine ADM coverage facilitates wound healing, decreases the length of hospital stay, and improves esthetic and functional results in extensive deep dermal burns of adult patients
Wang et al[51]	2020	Clinical Applications of Allograft Skin in Burn Care	This compact review summarizes the current use of ADMs and skin allografts in burns in the light of clear evidence
Chen et al[47]	2024	Multicenter effect analysis of one-step acellular dermis combined with autologous ultra-thin split thickness skin composite transplantation in treating burn and traumatic wounds	In this open, randomized, controlled, multicenter study, the authors suggest that ADMs can be successfully combined with partial-thickness skin grafts in many other acute traumatic and chronic non-burn wounds

Table 3 Clinical evidence examples of the utilization of acellular dermal matrix in various chronic wounds

Ref.	Year	Title	Note
Luthringer et al[56]	2020	Human-derived Acellular Dermal Matrix Grafts for Treatment of Diabetic Foot Ulcers: A Systematic Review and Meta-analysis	Authors conclude that Human-derived acellular dermal matrices (ADMs) are associated with a higher likelihood of complete healing and fewer days to complete healing within a 12-week and 16-week periods when compared with standard of care
Gormley et al[52]	2024	The use of fetal bovine acellular dermal matrix in severe diabetic foot ulceration and threatened limbs with tissue loss the use of FBADM as an adjunct for complex wounds	Authors conclude that ADM may be a useful adjunct in the acute setting of complex diabetic foot disease and critical limb-threating ischemia ulceration to assist with wound healing
Climov et al[53]	2016	The Role of Dermal Matrices in Treating Inflammatory and Diabetic Wounds	Authors review wide range of inflammatory wounds such as pyoderma gangrenosum, sickle cell ulcer, sarcoid ulcer as well as diabetic foot ulcer where ADMs may enhance the regenerative potential
Zelen et al[55]	2018	An aseptically processed, acellular, reticular, allogenic human dermis improves healing in diabetic foot ulcers: A prospective, randomised, controlled, multicentre follow-up trial	This randomized controlled trial demonstrates the effectiveness of the human derived ADM in facilitating the closure of nonhealing diabetic foot ulcers refractory to standard of care
Cazzell[58]	2019	A Randomized Controlled Trial Comparing a Human Acellular Dermal Matrix Versus Conventional Care for the Treatment of Venous Leg Ulcers	According to this multicenter, randomized, controlled, open-label trial, authors conclude that successful increase in healing rates and rate of percent wound closure in ADM application as compared with conventional care options
Strauss and Brietstein[59]	2012	Fetal Bovine Dermal Repair Scaffold Used for the Treatment of Difficult-to- Heal Complex Wounds	Authors conclude that ADMs can be used as part of an effective treatment regimen to heal complex wounds with exposed tendon/bone caused by varying etiologies

Table 4 Clinical evidence examples of the utilization of acellular dermal matrix in breast surgery

Ref.	Year	Title	Note
Sigalove et al[71]	2017	Prepectoral implant-based breast reconstruction: Rationale, indications, and preliminary results	In this report, the authors discuss the rationale for prepectoral implant reconstruction, its indications/contraindications, and preliminary results from over 350 reconstructions
Chopra et al[72]	2021	The Journey of Prepectoral Breast Reconstruction through Time	Authors review the breast reconstruction history and favor prepectoral implant placement. They also encourage the use of acellular dermal matrix (ADM)/Synthetic Mesh with prepectoral breast reconstruction as they are an efficient and effective mode of breast reconstruction, causing minimal morbidity whilst providing good cosmesis
Haddock et al[73]	2021	Prepectoral versus Subpectoral Tissue Expander Breast Reconstruction: A Historically Controlled, Propensity Score-Matched Comparison of Perioperative Outcomes	When compared two groups, authors found similar rates of overall perioperative complications. However, prepectoral placement might reduce unnecessary clinic visits; shorten the delay before adjuvant therapy, and minimize patient apprehension, pain, and discomfort related to clinic-based expansion
Nahabedian and Jacobson[67]	2019	Two-stage prepectoral breast reconstruction	Authors suggest that the prepectoral two-stage approach is indicated in the majority of patients and can be performed with fewer complications using ADM, especially in patients who will receive radiotherapy
Asaad et al[74]	2023	Surgical and Patient-Reported Outcomes of 694 Two-Stage Prepectoral versus Subpectoral Breast Reconstructions	A large population reconstructed with ADM. Analysis demonstrated overall similar complication rates between the two-implant plane
Sbitany et al[75]	2017	A Safe Alternative to Submuscular Prosthetic Reconstruction following Nipple-Sparing Mastectomy	After two-staged implant reconstructions with ADM, analysis revealed no difference in total complication rate between the two groups and no differences in any of the individual complications measured that included infection, seroma and explantation
Nahabedian and Spear[79]	2011	Acellular dermal matrix for secondary procedures following prosthetic breast reconstruction	Authors defines novel ADM involving techniques for correcting deformities and complications, such as rippling, displacement, capsular contracture etc.
Kaufman[78]	2012	Pocket reinforcement using acellular dermal matrices in revisionary breast augmentation	Author describes techniques for correcting deformities with ADM after primary breast augmentation

Table 5 Clinical evidence examples of the utilization of acellular dermal matrix in chest wall reconstruction

Ref.	Year	Title	Note
Sodha et al[85]	2012	The use of acellular dermal matrices in chest wall reconstruction	First review of acellular dermal matrix (ADM) utilization in chest wall defects. Authors share their experiences and conclude that they favor acellular dermal matrices when there is concern for possible field contamination, active infection, or concern over wound healing
Cothren et al[84]	2004	Chest wall reconstruction with acellular dermal matrix (AlloDerm) and a latissimus muscle flap	First case report utilizing ADM in a chest wall defect
Khalil et al[86]	2018	Chest Wall Reconstruction with Porcine Acellular Dermal Matrix (Strattice) and Autologous Tissue Transfer for High Risk Patients with Chest Wall Tumors	Reconstruction 7 sarcoma and 1 breast cancer resection involving chest wall. Authors encourage ADM use in chest wall reconstruction to resist infection in high-risk patients with extensive defects
Alshehri[87]	2023	Chest wall osteochondroma resection with biologic acellular bovine dermal mesh reconstruction in pediatric hereditary multiple exostoses: A case report and review of literature	Resection and ADM involving reconstruction of a 5-year-old
Delgado-Miguel et al[88]	2022	The Use of Acellular Dermal Matrix (Integra Single Layer) for the Correction of Malformative Chest Wall Deformities: First Case Series Reported	Four cases of congenital chest malformation

Table 6 Clinical evidence examples of the utilization of acellular dermal matrix in abdominal wall reconstruction

Ref.	Year	Title	Note
Zhong et al[96]	2011	Outcomes after abdominal wall reconstruction using acellular dermal matrix: a systematic review	Authors conclude the need for high-level evidence when comparing acellular dermal matrix (ADM) use with other methods to make data-driven recommendations on clinical indications, surgical techniques and outcomes following ADM-assisted abdominal wall reconstruction
Sbitany et al[98]	2015	Outcomes Analysis of Biologic Mesh Use for Abdominal Wall Reconstruction in Clean-Contaminated and Contaminated Ventral Hernia Repair	Authors conclude that single-stage repair of grade 3 hernias performed with component separation and biologic mesh reinforcement is effective and offers a low recurrence rate. The use of biologic mesh allows for avoidance of mesh explantation in instances of wound breakdown or infection. Bridging repairs are associated with a high recurrence rate, as is single-stage repair of grade 4 hernias
Atema et al[99]	2017	Major Complex Abdominal Wall Repair in Contaminated Fields with Use of a Non-cross-linked Biologic Mesh: A Dual-Institutional Experience	Author proposes that the repair of the most challenging abdominal wall defect can be done effectively with combination of a non-cross-linked biologic mesh and component separation technique without the need for mesh removal despite wound infections
Hassan et al[107]	2023	Outcomes of Complex Abdominal Wall Reconstruction After Oncologic Resection: 14-Year Experience at an NCI-Designated Cancer Center	Authors conclude that ADM-assisted abdominal wall repair after extirpative wall resections demonstrated comparable outcomes with primary herniorrhaphy
Giordano et al[108]	2024	Component Separation Decreases Hernia Recurrence Rates in Abdominal Wall Reconstruction with Biologic Mesh	Authors concluded that the component separation technique combined with ADM was associated with fewer hernia recurrences, while surgical site occurrence was similar in long-term follow-up despite additional surgery

Table 7 Clinical evidence examples of the utilization of acellular dermal matrix in head and neck

Ref.	Year	Title	Note
Shridharani and Tufaro[109]	2012	A systematic review of acelluar dermal matrices in head and neck reconstruction	First systematic review for the head and neck region
Gilardino et al[116]	2018	A Prospective Study Investigating Fistula Rate Following Primary Palatoplasty Using Acellular Dermal Matrix	This prospective study proposes the routine use of ADM in Veau II-IV clefts since it significantly reduce the fistula rate when compared their retrospective cohort
Linn et al[114]	2022	Comparison of the use of allogenic acellular dermal matrix on rates of Frey syndrome post parotidectomy: A systematic review and meta-analysis	Authors conclude that the use of ADM was associated with lower Frey syndrome rates compared to no ADM and should be considered in routine use to prevent this condition
Xu et al[112]	2021	Human-derived acellular dermal matrix may be an alternative to autologous grafts in tympanic membrane reconstruction: systematic review and meta-analysis	Authors conclude that human-derived ADM might be an effective alternative to autologous grafts for tympanoplasty
Girod et al[115]	2009	Acellular dermis compared to skin grafts in oral cavity reconstruction	Authors conclude that acellular dermis grafting for reconstruction of the oral cavity offers several advantages over split-thickness skin graft, including the lack of donor site morbidity, lower cost, a natural appearing mucosal surface, and comparable if not superior functional status
Warren et al[119]	2000	Dural repair using acellular human dermis: experience with 200 cases: technique assessment	Authors conclude that acellular human dermis is a reasonable alternative to the available dural graft materials. Its handling characteristics are similar to those of dura, it is biologically inert, and it does not produce adhesion formation
Zang et al[117]	2020	Comparison of xenogeneic acellular dermal matrix and skin grafts in reconstruction of postoperative defects of hypopharyngeal cancer: A retrospective cohort study	Authors conclude that both ADM and abdominal skin grafts demonstrated good effects in the reconstruction of hypopharynx, but the recovery time of eating function in patients with ADM was faster, which may be due to rapid epithelialization
Conrad et al[124]	2018	Acellular Human Dermal Allograft as a Graft for Nasal Septal Perforation Reconstruction	Authors conclude that as the first study to use objective and subjective measurements to confirm success with acellular dermis allograft as an adjunct for septal perforation repair it demonstrated a statistically significant reduction in patient nasal symptoms following repair
Grumbine et al[126]	2019	Correction of Lower Eyelid Retraction with En Glove Placement of Porcine Dermal Collagen Matrix Implant	Authors describe the technique for mild to moderate retractions. The operative time is brief (< 30 minutes), with limited dissection and resultant minimal to no clinically significant ocular surface inflammation postoperatively
Kook et al[110]	2023	Prevention and Resolution of Silicone Implant-Related Problems in Secondary Rhinoplasty Using a Cross-Linked Human Acellular Dermal Matrix	Authors conclude that dorsal augmentation using the cross-linked human ADM along with various nasal tip work using autogenous cartilage. Surgical outcome showed favorable resolution of contracture deformities, a low infection rate, firm fixation of the implant, good skin texture/thickness of the skin/soft tissue envelope and gain of desired height and dorsal line
Fisher et al[111]	2023	Current Practices in Dorsal Augmentation Rhinoplasty	Authors describe acellular dermal matrices are alternatives to autologous graft with many similar advantages and no need for an additional surgical site

Table 8 Clinical evidence examples of the utilization of acellular dermal matrix in extremity

Ref.	Year	Title	Note
Acevedo et al[128]	2015	Orthopedic applications of acellular human dermal allograft for shoulder and elbow surgery	Authors review a wide variety of orthopedical applications of acellular dermal matrices (ADMs) such as, rotator cuff tears, latissimus dorsi transfers, pectoralis major and biceps tendon repairs, glenoid resurfacing and acromioclavicular reconstruction
Cole et al[131]	2018	Achilles Tendon Augmented Repair Using Human Acellular Dermal Matrix: A Case Series	Authors report no cases of rerupture or complications that require additional treatment over average of 14.4 months of nine patient
Rabinovich and Lee[134]	2018	Proximal Row Carpectomy Using Decellularized Dermal Allograft	Authors describe their ADM-assisted resurfacing technique with illustration and figures
Hoang et al[135]	2019	Use of Acellular Dermal Matrix Following Fasciectomy for the Treatment of Dupuytren's Disease	Authors conclude that the adjunct placement of acellular dermal matrix into the wound bed following fasciectomy may be an important surgical strategy to reduce recurrence rates as well as augment coverage of exposed vital structures in cases of severe flexion contracture
Ellis and Kulber[37]	2012	Acellular dermal matrices in hand reconstruction	A comprehensive review for ADM-assisted reconstruction of difficult skin and soft tissue defects resulted from various etiologies such as, ischemia, infection, advanced Dupuytren disease and burn contractures
Shim et al[132]	2021	Preventing postoperative adhesions after hand tendon repair using acellular dermal matrix	Authors conclude that he use of ADM after tendon repair has the potential to significantly improve the outcome of tendon surgery in terms of range of motion