Reconstruction of Soft Tissue Defects using Multilayer of Acellular Human Dermal Allograft and Terudermis

Lee, Ho Nam; Kang, Sang Yoon; Park, Jun; Cho, Sang Hun

Abstract

Classically autologous split-thickness skin graft or flap surgery has been applied to the case of full-thickness skin defects. However, simple skin graft causes postoperative adhesion and scar contracture, and flap surgery could cause functional and aesthetic trouble due to the scar at the donor site. It is well known that the thicker dermis is transplanted, the lesser adhesion and contracture can be resulted. In spite of all advantages, this thicker layer of dermis can also cause pain, infection, hypertrophic scar and delayed healing at the donor site. Two treatments have been developed and applied to solve the problems mentioned above: one is acellular dermal matrix(Alloderm(R)) and the other is Terumo(R) as a silicon coated artificial dermis on the complex of fiberized collagen from calf skin and athecollagen. In the conventional treatment, skin graft is executed when one layer of Terumo(R) or Alloderm(R) is covered and its survival is sure. This method, however, showed certain limits in the appliance: delayed healing time, longer period of hospitalization and limits of dermis supplying, etc. We have applied multi-layer coverage of these materials with simultaneous or delayed skin graft to shorten healing time and to achieve a better effect of dermis. Among those who need flap surgery because of soft tissue defect, or when severe depression or scar contracture can be expected after surgery, a total of 13 cases have been studied: 7 multilayer Alloderm(R) graft with simultaneous thin split-thickness skin graft, and 6 multilayerTerumo(R) graft with delayed skin graft. In all cases, transplants were successful without any difficulties in healing process: no delayed healing time, no functional deficit as contracture, no contour deformity as depression or hypertrophy.