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Case Study
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Acellular scaffold material Òstands upÓ against skin graft on a major weight bearing surface Jeffrey A. Niezgoda, MD, FACHM, FACEP, Mary Verhage, RN, BSN, CWOCN Over the past 5 years, the options available to advanced wound care physicians and plastic and general surgeons for wound closure, temporary coverage, or stimulation of tissue growth has grown ten-fold. Full thickness and split-thickness skin grafting has been the Ògold standardÓ for tissue defect closure for decades. In cases where coverage is urgent and adequate autograft tissue is not available or advisable, xenograft and allograft materials have been utilized. This option is temporary, offering a biologic dressing that will eventually be replaced by other means. Recently living tissue replacements grown in the laboratory from neonatal cell sources have been proven to be effective in stimulating tissue growth and closing wounds. These bioengineered tissues are living, growing, replicating cells. Special care must be taken to ensure that these living cells have optimal growth environments and are protected from trauma and infection. In addition to the living tissue materials, there are several Ògraft replacementsÓ that are created from previously living tissue sources; human, bovine, and porcine. The cellular components are extricated and a scaffolding of matrix materials containing collagen, elastin, fibronectin, and growth factors remains. This material due to its acellular nature does not elicit graft material rejection Choosing the appropriate graft material requires consideration of the wound, its natural history, location, and goal of grafting. The material itself and its properties must be weighed against the potential outcomes. We present the case of a 53-year-old man with a radical partial calcanectomy requiring tissue replacement/coverage. There were no local flaps available in the area to cover such a large portion of his heel. Skin grafting would be inadequate for coverage over bone and the entire weight bearing heel surface. An acellular sheet of cadaveric tissue was chosen to close this wound. Adjunctive therapies included negative pressure wound therapy and hyperbaric oxygen treatments. Brigido SA, Boc SF, Lopez RC. Effective management of major lower estremity wounds using an acellular regenerative tissue matrix: a pilot study. Orthopedics. 2004;27(1 Supp):145Ð149 Naughton G, Mansbridge J, Gentkow G. A metabolically active human dermal replacement for the treatment of diabetic foot ulcers. Artif Organs. 1997;21(11):1203Ð1210. |
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