Acellular Dermal Matrix for Temporary Coverage of Exposed Critical Neurovascular Structures in Extremity Wounds

Author(s): Bastidas N, Ashjian PJ, Sharma S

Source: Ann Plast Surg 62: 410–413, 2009.

Summary:

Large-volume soft-tissue defects may leave exposed neurovascular structures that are not amenable to immediate soft-tissue coverage. In this prospective study, the authors describe their experience with temporary extremity vital structure coverage with human acellular dermal allograft.

Temporary soft tissue coverage of exposed neurovascular structures was obtained In 25 patients following trauma or oncologic ablation with thick human acellular dermal allograft.  These extremity wounds were deemed to be not amenable to immediate definitive soft-tissue reconstruction.   Three to 12 days later, the allograft was removed, the neurovascular structures examined, and definitive soft-tissue reconstruction was achieved.  The authors conclude that thick human acellular dermal allograft offers a safe and reliable alternative to cover critical neurovascular structures temporarily, before the definitive reconstruction of soft-tissue defects.

The management of complex soft-tissue defects may be complicated by the presence of neurovascular structures within the wound bed.  In certain instances, immediate definitive wound coverage may not be warranted and multi-stage reconstruction is the safer alternative.  In this study, human acellular dermal allograft proved to be an expensive, yet safe biological dressing that was found to adequately protect vital neurovascular structures.  An alternative to this method is to use thin allograft that allows incorporation and vascularization (thick allograft does neither).  The thin allograft can be secondarily split-thickness skin grafted or allowed to simply contract with excellent functional and aesthetic results.