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Acellular Dermal Matrix (ADM) For Burn and Trauma Wounds

Acellular Dermal Matrix (ADM) For Burn and Trauma Wounds

In full-thickness skin defects, involving the epidermis, dermis, and subcutaneous tissue, skin grafting is a common method for repair. Traditional grafting involves cutting the patient’s own skin for transplantation, with variations like ultra-thin split-thickness, medium-thickness, and full-thickness grafts depending on skin thickness and structure. While these methods can achieve good tissue appearance and wear resistance, they have drawbacks, such as scarring and limited donor skin.

The use of Acellular Dermal Matrix (ADM) technology involves removing the epidermis and cells from skin tissue while preserving its structure and extracellular matrix. When implanted, ADM shows excellent compatibility, low rejection risk, and promotes tissue regeneration. A combination of ADM with autologous ultra-thin split-thickness skin grafting can address the limitations of single-layer grafts and donor area damage.

By retaining this extracellular matrix, ADM technology offers numerous advantages. It provides a biocompatible and supportive scaffold that can be used in various medical applications, such as skin grafting, wound repair, and tissue reconstruction. This scaffold acts as a foundation for the body’s own cells to populate and regenerate, making it an invaluable tool in the field of regenerative medicine.

However, current ADM methods typically involve a two-step process, making treatment cumbersome and prolonging hospital stays. This study compares the one-step acellular dermis combined with autologous ultra-thin split-thickness skin grafting to the traditional single-layer thick and medium-thick skin grafting. The research aims to provide insights into the safe use of one-step decellularized dermis for treating burn wounds.

Study Methods 

From January 2019 to December 2021, an extensive clinical study was conducted across multiple centers in China, involving patients who had undergone skin grafting procedures for wound repair. This trial, characterized as an open, randomized, controlled, multicenter experiment, aimed to evaluate the combination of traditional skin graft repair with acellular dermis and autologous ultra-thin split-thickness skin composite transplantation. This research was carried out in three medical centers spanning two provinces.

The primary endpoint for this study was set at six months following the patient’s discharge. Ethical considerations were given a high priority, as the trial was approved by the institutional review boards of the participating hospitals, and all patients willingly provided written informed consent.

In terms of patient selection, certain inclusion and exclusion criteria were applied. Inclusion criteria encompassed patients with a hospital stay of at least 24 hours, those with clear consciousness and the ability to communicate effectively, and medical records free from significant omissions. Exclusion criteria comprised patients with specific medical conditions, extensive burn areas, compound injuries, mental illnesses affecting cooperation with long-term treatment, chronic diseases influencing wound healing, and those unable to participate in follow-up assessments.

The study enrolled a total of 3610 patients who underwent skin grafting procedures across the participating centers. After applying the exclusion criteria, 1208 patients remained. These patients were further categorized into groups based on the method of skin grafting and the cause of their injuries. The study group exhibited a diverse age range, spanning from 2 to 71 years, with a mean age of 39 years. The gender distribution included 997 males and 211 females, with 12 pediatric patients.

Within the study group, various injury causes were observed, including trauma and burns, affecting different body regions. Trauma cases involved injuries to the foot, ankle, lower leg, thigh, wrist, upper limb, trunk, and head/face/neck, while burn cases also exhibited a similar pattern of injury distribution.

This comprehensive research aimed to shed light on the efficacy and outcomes of combining different skin grafting techniques, offering valuable insights into wound repair and healing.

Surgery and Treatment Procedure 

Patients receive a preoperative examination to stabilize their health and address issues like anemia and low protein levels that could hinder wound healing. Surgical interventions, wound debridement, and dressing changes are performed until the wound is devoid of necrotic tissue, exhibits fresh granulation, and no longer exposes tendons, bones, vessels, or nerves. Preoperative bacterial cultures are checked to ensure readiness for skin grafting.

During surgery, the wound is rinsed with a saline-chlorhexidine solution, excessive tissue is removed, and decellularized dermal material is applied based on wound size. This material is secured with sutures, and in some cases, autologous dermal transplantation is employed using various skin sheets for specific areas. Subsequently, the wound is dressed and bandaged.

After surgery, patients undergo active treatments such as skin graft immobilization and nutritional support. Skin survival is observed for 7 days.

Wounds with skin survival rates between 80% and 100% undergo dressing changes to facilitate healing. For wounds with less than 60% skin survival or between 60% and 80%, additional skin grafts are considered, accompanied by continued dressing changes until complete healing is achieved. Post-surgery, patients are encouraged to engage in physical activity, wear elastic clothing to mitigate scarring, and receive other relevant treatments.

Statistical Analysis 

The database was set up using Microsoft Excel 2017, and for statistical analysis, SPSS 20.0 software was employed. Frequency and percentage expressed the counting data, while mean ± standard deviation (x̄±s) described the measurement data. To make comparisons, the χ2 test and t-test were applied. Both total hospitalization cost and total surgical cost followed a logarithmic transformation and exhibited a normal distribution. A significance level of p < 0.05 was used to determine statistical significance.

Final Thoughts 

In summary, the one-step procedure involving decellularized allogeneic dermis combined with thick skin sheet transplantation technology serves not only as a solution for deep burn wounds but is also extensively applied in a wide spectrum of cases, including acute traumatic wounds, chronic wounds, donor site injuries, muscle valve surfaces, and other types of wounds.

This approach offers the advantage of achieving superior wound healing outcomes in the affected area while minimizing scarring in the donor region. This innovative technique goes well beyond burn care, finding relevance in various medical contexts. It becomes a valuable tool in managing acute traumatic wounds, which may result from accidents, injuries, or surgical procedures. These wounds often require meticulous care to ensure optimal healing and minimize complications, and the combination of the decellularized allogeneic dermis with thick skin sheets offers a compelling solution. Furthermore, the procedure is a promising option for chronic wounds, which are often stubborn and resistant to conventional treatments. The regenerative properties of decellularized allogeneic dermis, combined with the structural support provided by thick skin sheets, contribute to enhanced healing in these challenging cases.

When compared to the conventional techniques of single ultra-thin split-thickness skin sheet, medium-thick skin sheet, and full-thick skin sheet transplantation, this method yields equivalent wound healing times and results in flat wound appearance, good elasticity, enhanced mobility, and reduced scarring. As such, it merits further consideration and adoption within clinical practice. 

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