Acellular dermal matrix in reconstructive surgery: Applications, benefits, and cost

Abstract

Modern tissue engineering has made substantial advancements that have revolutionized plastic surgery. Acellular dermal matrix (ADM) is an example that has gained considerable attention recently. ADM can be made from humans, bovines, or porcine tissues. ADM acts as a scaffold that incorporates into the recipient tissue. It is gradually infiltrated by fibroblasts and vascularized. Fortunately, many techniques have been used to remove cellular and antigenic components from ADM to minimize immune system rejection. ADM is made of collagen, fibronectin, elastin, laminin, glycosaminoglycans, and hyaluronic acid. It is used in critical wounds (e.g., diabetic wounds) to protect soft tissue and accelerate wound healing. It is also used in implant-based breast reconstruction surgery to improve aesthetic outcomes and reduce capsule contracture risk. ADM has also gained attention in abdominal and chest wall defects. Some studies have shown that ADM is associated with less erosion and infection in abdominal hernias than synthetic meshes. However, its higher cost prevents it from being commonly used in hernia repair. Also, using ADM in tendon repair (e.g., Achilles tendon) has been associated with increased stability and reduced rejection rate. Despite its advantages, ADM might result in complications such as hematoma, seroma, necrosis, and infection. Moreover, ADM is expensive, making it an unsuitable option for many patients. Finally, the literature on ADM is insufficient, and more research on the results of ADM usage in surgeries is needed. This article aims to review the literature regarding the application, Benefits, and costs of ADM in reconstructive surgery.

Assessment of inflammatory suppression and fibroblast infiltration in tissue remodelling by supercritical CO2 acellular dermal matrix (scADM) utilizing Sprague Dawley models

“…Acellular dermal matrix (ADM) application in preventing complications in implant-based breast surgeries or soft tissue substitution has been reported in several studies ( Macadam and Lennox, 2012 ; Gravina et al, 2019 ; Mohammadyari et al, 2023 ). ADM is fabricated by the removal of cellular components from the dermal compartment, exhibiting natural bioactive signals, suitable compatibility with living tissues, and mechanical characteristics, which thus functions as a structural scaffold consisting of extracellular matrix components ( Nikolova and Chavali, 2019 ; Dussoyer et al, 2020 ).…”

Implant-Based Breast Reconstruction after Risk-Reducing Mastectomy in BRCA Mutation Carriers: A Single-Center Retrospective Study

“…Thanks to the absence of cellular and antigenic components, an ADM is a non-immunogenic material that helps to avoid the drawbacks related to the host’s immunological response. Moreover, it overcomes the disadvantages related to autologous tissue grafts and synthetic materials, represented by a secondary donor-site morbidity and a high risk of infection, respectively [ 31 , 101 ].…”

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“…Acellular dermal matrix (ADM) application in preventing complications in implant-based breast surgeries or soft tissue substitution has been reported in several studies (Macadam and Lennox, 2012;Gravina et al, 2019;Mohammadyari et al, 2023). ADM is fabricated by the removal of cellular components from the dermal compartment, exhibiting natural bioactive signals, suitable compatibility with living tissues, and mechanical characteristics, which thus functions as a structural scaffold consisting of extracellular matrix components (Nikolova and Chavali, 2019;Dussoyer et al, 2020).…”