• 【脱细胞真皮基质同种异体的证据基础: 系统评价。】 复制标题 收藏 收藏
    DOI:10.1097/SAP.0b013e31827a2d23 复制DOI
    作者列表:Jansen LA,De Caigny P,Guay NA,Lineaweaver WC,Shokrollahi K
    BACKGROUND & AIMS: BACKGROUND:Many decellularized dermal matrices are available with various applications, all with slight differences. AlloDerm appears to have the greatest presence in the literature. The purpose of this systematic review is to provide an overview of the experience with AlloDerm, stratified by clinical indication. METHODS:A literature search was performed across Medline, EMBASE, and the Cochrane Collaboration using the search terms "AlloDerm" and "acellular dermal matrix." Two independent authors applied a priori inclusion and exclusion criteria. Relevant articles were categorized by application, type of study, and evidence level. RESULTS:A total of 753 articles met the initial inclusion criteria, and 311 remained after discarding irrelevant articles: skin (25), head and neck (82), breast (34), trunk (66), pelvis (10), extremities (8), and basic science (86). Non-basic science study designs included 32 analytic articles (3 randomized controlled trials and 29 observational studies including 11 cohort studies, 1 cross-sectional study, and 17 case-controlled studies), 192 descriptive articles (106 case series, 51 case reports, 2 cross-sectional studies, and 33 qualitative studies), and 1 systematic review. More than 85% of articles had a level of evidence of 4 or 5. Articles showed outcomes that were 70% positive, 23% neutral, and 7% negative. CONCLUSIONS:AlloDerm has many clinical uses with promising results. Most evidence lies in descriptive and nonrandomized studies, but randomized trials are emerging. Cost and logistics of large trials with these products make large-scale trials challenging but necessary. Emphasis needs to shift to randomized controlled trials focusing on areas where most clinical benefit can be realized.
    背景与目标:
  • 【同种异体移植 (异体) 和自体移植 (颞肌筋膜) 植入治疗声门功能不全: 一种新方法。】 复制标题 收藏 收藏
    DOI:10.1016/j.jvoice.2010.08.001 复制DOI
    作者列表:Tan M,Bassiri-Tehrani M,Woo P
    BACKGROUND & AIMS: OBJECTIVE:Traditionally, glottic insufficiency because of scar, atrophy, and sulcus has been treated by injection or medialization laryngoplasty. These procedures do not reestablish the vertical height of the vocal fold margin. We propose soft tissue augmentation laryngoplasty with allograft (sheet Alloderm; LifeCell Corporation, Branchburg, NJ) or autograft (temporalis fascia) via a minithyrotomy or a transoral approach. STUDY DESIGN:A retrospective case series analysis of 21 patients treated by sheet Alloderm or temporalis fascia for correction of glottic insufficiency. METHODS:Twenty-one patients with glottic insufficiency secondary to scar, atrophy, or sulcus were treated. Ten failed prior techniques. Seventeen had minithyrotomy by a small fenestration in the thyroid cartilage. Exploration of scar or lamina propria through the fenestration allowed for the creation of a pocket for Alloderm implantation within the intermediate layer of the lamina propria. Four patients underwent a transoral approach by cordotomy with either Alloderm or temporalis fascia implantation, which also allowed for exploration of scar but required repair using sutures. These implantation approaches allowed for both restoration of the layered structure and augmentation of the middle third of the musculomembranous vocal fold. Preoperative and postoperative videostroboscopic examinations were reviewed with review of clinical outcome. RESULTS:With a median follow-up time of 12 months, patients demonstrated excellent long-term vocal fold augmentation and minimal absorption of the implant in 19 out of 21 patients. There is improved pliability of the vocal fold with good oscillation in scar patients. CONCLUSION:Minithyrotomy with soft tissue augmentation is a novel approach for soft tissue augmentation of glottic insufficiency. It has the advantage of augmentation of the medial edge of the vocal fold with a soft tissue implant that has long-term viability. Its role should be explored further in patients with atrophy and scar.
    背景与目标:
  • 【Alloderm和Dermacell在即刻同种异体乳房重建中的患者报告结果的比较: 一项随机对照试验。】 复制标题 收藏 收藏
    DOI:10.1016/j.bjps.2020.08.018 复制DOI
    作者列表:Stein MJ,Arnaout A,Lichtenstein JB,Frank SG,Cordeiro E,Roberts A,Ghaedi B,Zhang J
    BACKGROUND & AIMS: BACKGROUND:Alloderm and Dermacell are the two leading human acellular dermal matrices (ADM) in immediate breast reconstruction (IBR). Despite differences in sterility, consistency, thickness and cost, there are no comparative trials to date to compare patient-reported outcome measures (PROM) between the two products. The purpose of this study was to determine if there was a difference in patient-reported outcomes (as measured by the BREAST-Q) between patients reconstructed with Alloderm and Dermacell. METHODS:A single center, open-label, randomized control trial of patients undergoing IBR with an implant for breast cancer or breast cancer prophylaxis was performed. Patients were randomized to either Alloderm or Dermacell. Baseline demographic data were compared, and linear mixed models were used to identify associations with BREAST-Q over time. RESULTS:Between June 2016 and October 2018, 62 patients were randomized into two groups, 31(50%) Alloderm and 31(50%) Dermacell. Of these, 23(74%) patients in the Alloderm group and 27(87%) patients of the Dermacell group filled out BREAST-Q questionnaires. Baseline BREAST-Q scores with respect to satisfaction with breasts, psychosocial well-being, sexual well-being, and physical well-being were similar between groups (p>0.05). At 3 months postoperatively, the Alloderm group had a statistically significant improvement with respect to satisfaction with breasts (67 vs 53, p = 0.03), satisfaction with overall results (85 vs 61, p = 0.003), satisfaction with the surgeon (89 vs 67, p = 0.01), and satisfaction with information provided (74 vs 59, p = 0.02). At 12 months postoperatively, there were no statistically significant differences in PROM between groups (p>0.05). CONCLUSION:We report the first randomized controlled trial to date comparing patient-reported outcomes of the two most commonly used ADMs in IBR in Canada. Although a short-term analysis favors the use of Alloderm, there does not appear to be any difference in outcomes between the two products in the longer term.
    背景与目标:
  • 【异体修复支气管食管瘘。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2008.12.091 复制DOI
    作者列表:Morse CR
    BACKGROUND & AIMS: :We describe the use of Alloderm (LifeCell Corp, Branchburg, NJ), a biologic scaffold, to repair a large fistula between the proximal left mainstem bronchus and the esophagus.
    背景与目标: : 我们描述了使用Alloderm (LifeCell Corp,Branchburg,NJ) (一种生物支架) 来修复近端左主干支气管和食道之间的大瘘管。
  • 【急诊手术后需要复杂腹部闭合的患者感染的无细胞真皮基质 (AlloDerm) 的微生物学。】 复制标题 收藏 收藏
    DOI:10.1089/sur.2008.082 复制DOI
    作者列表:Awad SS,Rao RK,Berger DH,Albo D,Bellows CF
    BACKGROUND & AIMS: BACKGROUND:Acellular dermal matrix (AlloDerm) has recently been introduced as an option for complex abdominal closure for patients with loss of abdominal wall domain secondary to intra-abdominal sepsis or necrotizing fasciitis. AlloDerm has been touted as a promoter of neovascularization and collagen deposition. Currently, the rate of AlloDerm infection in contaminated cases is unknown. Our objective was to determine if the organisms cultured during source control would infect AlloDerm. METHODS:The medical records of patients who required complex abdominal closure with AlloDerm in a tertiary-care hospital were reviewed from January to December, 2005. For each patient demographic, the reason for urgent surgery, American Society of Anesthesiologists (ASA) class, Acute Physiology and Chronic Health Evaluation (APACHE) II score, serum albumin concentration, culture results of purulent fluid obtained during surgery, and culture results of biopsies of infected-appearing AlloDerm (change of color, delayed granulation, odor) were collected. Data are presented as mean +/- standard error of the mean. RESULTS:Seventeen patients required the use of AlloDerm for tension-free closure of the abdominal wall after surgery for source control in necrotizing fasciitis (13%) or intra-abdominal sepsis (87%). The mean age was 61 +/- 2 years; 73% of the patients were Caucasian, the remainder being African American. The mean APACHE II score was 23.7 +/- 2.0, and the median ASA class was 3. The mean preoperative albumin concentration was 2.27 +/- 0.26 g/dL. Most (76%) of the patients had a wound vacuum-assisted closure system placed over the AlloDerm. Four patients (24%) were noted to have an infection of the AlloDerm graft at 24 +/- 10 days postoperatively. The cultures obtained at operation and from infected AlloDerm show similar organisms (Pseudomonas in two, Escherichia coli and methicillin-resistant Staphylococcus aureus in one each). Infected AlloDerm was coated with silver sulfadiazene and moistened dressings, and all four patients had complete resolution of the AlloDerm infection with an adequate bed of granulation tissue, allowing skin grafting. CONCLUSION:Patients with contaminated abdomens who require complex closure with AlloDerm are at risk of developing infection of their graft material with organisms similar to those present at the time of surgery. Once culture results are obtained, topical antimicrobials with activity against the cultured organisms may be employed as part of the AlloDerm dressings to prevent infection and promote healing.
    背景与目标:
  • 【异体脱细胞真皮移植: 在美学软组织增强中的应用。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Terino EO
    BACKGROUND & AIMS: The advantages of Alloderm outweigh its disadvantages. This material provides a natural alternative to alloplastic materials in certain situations. Alloderm integrates into the patient's tissue, eliminating concerns associated with alloplastic material. Because it is of human origin, there is a remarkable lack of tissue reactivity after implantation. Volume persistence remains a concern. Because reports vary, the surgeon must determine the degree of persistence in his or her own hands and use larger pieces or multiple layers if necessary. Currently, Alloderm acellular human dermal tissue seems to be a successful modality for soft-tissue augmentation to improve various aesthetic and reconstructive deficiencies.

    背景与目标: Alloderm的优点大于缺点。在某些情况下,这种材料提供了同种异体材料的天然替代品。Alloderm整合到患者的组织中,消除了与同种异体材料相关的担忧。由于它是人类起源的,因此植入后明显缺乏组织反应性。交易量的持久性仍然令人担忧。由于报告各不相同,因此外科医生必须确定自己手中的持久性程度,并在必要时使用较大的碎片或多层。目前,同种异体脱细胞人类真皮组织似乎是改善各种美学和重建缺陷的软组织增强的成功方式。
  • 【颊粘膜收获后使用异胚层闭合口腔内缺损的初步报告。】 复制标题 收藏 收藏
    DOI:10.1016/j.urology.2006.12.008 复制DOI
    作者列表:Kellner DS,Fracchia JA,Voigt E,Armenakas NA
    BACKGROUND & AIMS: :The ideal method for managing the intraoral defect after harvesting buccal mucosa for urethral reconstruction has not been clearly established. We describe a novel technique using AlloDerm to cover the harvest site, providing a simple means for a potentially less painful tension-free closure.
    背景与目标: : 尚未明确建立用于获取颊粘膜进行尿道重建后处理口腔内缺损的理想方法。我们描述了一种使用AlloDerm覆盖收获部位的新技术,为可能不那么痛苦的无张力闭合提供了一种简单的方法。
  • 【PET/CT模拟子宫癌肉瘤复发的同种异体移植物。】 复制标题 收藏 收藏
    DOI:10.3109/01443615.2013.841131 复制DOI
    作者列表:Adams BN,Musa FB,Taylor J,Holcomb K
    BACKGROUND & AIMS: -2
    背景与目标: -2
  • 【部分异体悬吊: 降低与乳房重建相关的同种异体移植成本。】 复制标题 收藏 收藏
    DOI:10.1016/j.bjps.2012.02.016 复制DOI
    作者列表:Chepla KJ,Dagget JR,Soltanian HT
    BACKGROUND & AIMS: BACKGROUND:Many surgeons now incorporate Acellular Dermal Matrix (ADM) into expander-based breast reconstruction. ADM is safe, provides full expander coverage, eliminates the need for additional muscular dissection and has improved aesthetic outcomes. However, its use increases surgical costs. Whether this cost is offset by decreased operative times or a reduced number of revision procedures is unknown. METHODS:We have developed a new technique that minimises the amount of ADM required in many patients. The 'partial sling' approach has been used for 145 consecutive patients (197 breasts) by a single surgeon from 2007 to 2010. After mastectomy, any portion of the pectoralis major insertion at, or <1 cm from, the planned inframmary fold is left intact and becomes the inferior margin of the expander pocket. The minimal size of ADM required is then determined by measuring from the pectoralis to the lateral breast margin. In this study, we exclusively used AlloDerm. Preoperative breast measurements, intra-operative fill volume, time to exchange procedure, number of expansion procedures and complications were recorded for all patients. RESULTS:Patients were grouped according to the surface area (cm(2)) of ADM required. Good aesthetic outcomes were obtained in all groups. Two groups had a significant difference in intra-operative fill volumes but this did not correlate to an increase in the number of expansion procedures required. Of 197 reconstructed breasts less than 64 cm(2) of ADM was used for 40 breasts (20%). CONCLUSIONS:The partial AlloDerm sling can minimise the costs associated with ADM use in breast reconstruction for many patients without increasing complications or altering aesthetic outcomes.
    背景与目标:
  • 【异胚层对人新血管的起始和生长的影响。】 复制标题 收藏 收藏
    DOI:10.1002/lary.20679 复制DOI
    作者列表:Weiss SR,Tenney JM,Thomson JL,Anthony CT,Chiu ES,Friedlander PL,Woltering EA
    BACKGROUND & AIMS: OBJECTIVES/HYPOTHESIS:AlloDerm (LifeCell Corp., Branchburg, NJ) is commonly employed for reconstruction of ablative soft tissue and mucosal defects following surgical resections. Although devoid of growth factors, AlloDerm may serve as an adhesive matrix for binding of growth factors, increasing local angiogenesis, and wound healing. We hypothesized that AlloDerm would enhance angiogenesis and might be altered with autologous blood products to enhance initiation of the angiogenic response. METHODS:We used a human placental vein in a fibrin-thrombin clot-based angiogenesis model. Four groups, human placental vein (HPVM), HPVM with AlloDerm, HPVM with AlloDerm plus platelet-poor plasma, and HPVM with AlloDerm plus platelet-rich plasma were evaluated. Endothelial cell growth was evaluated visually (40x). Hematoxylin and eosin staining and immunofluorescent staining for growth within the AlloDerm matrix were also performed. To assess human umbilical vein endothelial cell (HUVEC) sites of attachment to AlloDerm, we incubated HUVEC cells with AlloDerm for a period of 2 weeks and evaluated attachment with anti-factor VIII immunofluorescence. RESULTS:Angiogenic initiation decreased in the combined placental vein with AlloDerm group (P < .0001 at day 7, 14, 21). Additionally, initiation in the AlloDerm plus platelet-poor plasma group was significantly better than the AlloDerm alone group when placentas 2 and 3 were compared (P < .0001). On hematoxylin and eosin staining and immunofluorescent factor VIII staining, no endothelial growth into the AlloDerm was noted in the samples analyzed. CONCLUSIONS:AlloDerm may be enriched with platelet-poor plasma to stimulate greater initiation and wound healing; however, AlloDerm inhibits angiogenic initiation in this model.
    背景与目标:
  • 【脱细胞真皮移植 (AlloDerm) 用于癌症去除后上眼睑的重建。】 复制标题 收藏 收藏
    DOI:10.1097/IOP.0b013e3181b78989 复制DOI
    作者列表:Hayek B,Hatef E,Nguyen M,Ho V,Hsu A,Esmaeli B
    BACKGROUND & AIMS: PURPOSE:To report the use of AlloDerm for reconstruction of large upper eyelid defects in cancer patients. METHODS:The clinical records of all patients who had AlloDerm as part of their upper eyelid reconstruction between July 2005 and July 2006 at a single institution were reviewed. Functional and cosmetic outcomes and postoperative complications were assessed. RESULTS:Two patients had recurrent sebaceous gland carcinoma, 2 had melanoma, and 1 had squamous cell carcinoma. The upper eyelid defect involved the full thickness and entire width of the upper eyelid in 4 patients and full thickness and two thirds of the upper eye eyelid in 1 patient. The reconstructive procedure included a modified Cutler-Beard procedure using AlloDerm as the posterior lamellar sandwich graft in all 5 patients. One patient had early postoperative adjuvant radiation therapy to the upper eyelid. Three patients had excellent functional and cosmetic outcome; 2 patients had satisfactory outcomes. Two patients had residual exposure keratopathy. Allergic reaction to AlloDerm, infectious transmission, and immunologic rejection were not encountered at the time of this report (mean follow-up time = 13 months). CONCLUSIONS:AlloDerm can be used as an alternative sandwich graft material to replace the tarsus for reconstruction of large upper eyelid defects using a modified Cutler-Beard procedure.
    背景与目标:
  • 【AlloDerm和Strattice在乳房再造中的应用: 优化结果的比较和技术。】 复制标题 收藏 收藏
    DOI:10.1097/PRS.0b013e31824ec429 复制DOI
    作者列表:Glasberg SB,Light D
    BACKGROUND & AIMS: BACKGROUND:Acellular dermal matrices are increasingly used to reinforce the lower pole of the breast during tissue expander/implant breast reconstruction. Although a low complication rate and good aesthetic outcome have been reported, meticulous technique is important for success. This retrospective study compared the clinical course and postoperative outcome of women who underwent breast reconstruction using AlloDerm or Strattice in the authors' practice and highlights key technical considerations that are important for optimizing outcomes. METHODS:Patient records were reviewed for demographic data, operative parameters (length and volume of drainage), and type and frequency of postoperative complications, which were compared between the AlloDerm and Strattice groups. Biopsy specimens of acellular dermal matrices were taken for histologic analyses. RESULTS:Ninety-six patients (126 reconstructions) received AlloDerm, and 90 (144 reconstructions) received Strattice. Total complications were significantly higher with AlloDerm (21.4 percent versus 6.3 percent; p = 0.0003) and were driven by a significantly higher seroma rate (12.7 percent versus 1.4 percent; p = 0.0003). All other complications were similar between the groups. The capsular contracture rate (grade 1 or 2) was 2.4 percent with AlloDerm and 2.8 percent with Strattice, indicating that both may play a role in capsule formation. This was supported by histologic analyses indicating an absence of synovia-like metaplasia at the acellular dermal matrix/tissue expander interface. CONCLUSIONS:: Complications in this series were of low severity, which, together with consistent clinical outcomes seen in the authors' practice, justifies the cost associated with the use of acellular dermal matrices in breast reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE:Therapeutic: III.
    背景与目标:
  • 【无细胞尸体真皮 (AlloDerm): 腹部疝修补术的新选择。】 复制标题 收藏 收藏
    DOI:10.1097/01.sap.0000100895.41198.27 复制DOI
    作者列表:Buinewicz B,Rosen B
    BACKGROUND & AIMS: :AlloDerm is an intact human tissue matrix with the critical biochemical and structural components of the dermal extracellular scaffold that enable it to recellularize and revascularize. Its biologic nature provides AlloDerm with an improved capacity to reintegrate with surrounding tissues and less inclination toward infection, erosion, extrusion, and rejection compared with synthetic tissue replacement materials. This retrospective review describes the experience with AlloDerm for incisional hernia and transverse rectus abdominis musculocutaneous flap reconstructions at a plastic surgery practice that handles complex, nonprimary repairs. AlloDerm was observed to provide exceptional safety and tolerability, and to become reintegrated and vascularized with surrounding tissue for tolerable and persistent tissue replacement.
    背景与目标: : AlloDerm是一种完整的人体组织基质,具有真皮细胞外支架的关键生化和结构成分,使其能够再细胞化和再血管化。与合成组织替代材料相比,其生物学特性为同种异体提供了改善的与周围组织重新整合的能力,并且对感染,侵蚀,挤压和排斥的倾向较小。这项回顾性研究描述了在整形外科实践中进行切口疝和腹直肌横肌肌皮瓣重建术的经验,该手术可处理复杂的非原发性修复。观察到AlloDerm可提供出色的安全性和耐受性,并与周围组织重新整合并血管化,以进行耐受性和持续性的组织置换。
  • 14 The utility of Alloderm in hand resurfacing. 复制标题 收藏 收藏

    【Alloderm在手重铺中的效用。】 复制标题 收藏 收藏
    DOI:10.1016/j.bjps.2009.05.027 复制DOI
    作者列表:Eo S,Cho S,Shin H,Kim JY
    BACKGROUND & AIMS: :Alloderm as a biomechanical scaffold in situations such as skin grafting has been previously demonstrated. In this paper we describe its utility in a broad range of post-traumatic and congenital hand defects. During the recent three years, 11 patients (7 male, 4 female) ranging in age from 8 to 84 years underwent hand resurfacing using acellular dermis graft. There were 10 traumatic and 1 congenital hand deformities (constriction ring syndrome). The acellular dermis was used as both a dermal filler and as a spacer construct. There was no obvious loss of the acellular dermis or infection. Stable resurfacing was achieved in all patients with reasonable functional and cosmetic outcomes.
    背景与目标: : 在植皮等情况下,同种异体作为生物力学支架已被证明。在本文中,我们描述了它在创伤后和先天性手部缺陷中的用途。在最近的三年中,使用脱细胞真皮移植物进行了11例年龄在8至84岁之间的患者 (7例男性,4例女性) 的手表面置换。有10例外伤性和1例先天性手畸形 (缩环综合征)。脱细胞真皮既用作真皮填充剂,又用作间隔物。无明显脱细胞真皮或感染。所有具有合理功能和美容效果的患者均获得了稳定的表面置换。
  • 【瘢痕疙瘩治疗: 无细胞人类真皮 (Alloderm) 有作用吗?】 复制标题 收藏 收藏
    DOI:10.1016/j.bjps.2009.07.032 复制DOI
    作者列表:Patel NP,Lawrence Cervino A
    BACKGROUND & AIMS: BACKGROUND:Keloid management is faced with high recurrence rates. Keloid fibroblasts lack the normal negative feedback mechanism resulting in an exuberant scar formation. Alloderm doesn't undergo the same proliferative process as keloidal scar dermis. OBJECTIVE:To evaluate Alloderm as a treatment modality for keloids METHODS:A retrospective chart review of six patients with a total of eight large recurrent keloids was performed. Patients were treated with excision of the keloid followed by placement of Alloderm. Each patient was evaluated for recurrence and complications. RESULTS:During follow-up ranging from 1 month to 4(1/2) years there were 0% recurrences. Two out of 8 (25%) had residual induration. one of the two patients with residual induration, required an intralesional injection of kenalog at 6 months post-op. CONCLUSION:Our results from this small study show that with the use of Alloderm after keloid excision, recurrence is low. Further study is warranted.
    背景与目标:

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