Abstract
Free tissue transfer has revolutionized lower extremity reconstruction; however, its
use in elderly patients with multiple medical problems can be associated with elevated
rate
s of perioperative morbidity and mortality. This study evaluates the use of acellular
dermal matrix (ADM) in conjunction with negative pressure wound therapy (NPWT) and
delayed skin graft application as an alternative to free tissue transfer in this compromised
population. Bilayer, ADM (Integra, Plainsboro, NJ) was used in conjunction with NPWT
(Wound V.A.C, Kinetic Concepts Inc., San Antonio, TX) to achieve vascularized coverage
of complex lower extremity wounds with denuded tendon and bone in elderly, medically
compromised patients. Following incorporation, the matrix was covered with split-thickness
skin graft. Four patients (age range, 50 to 76 years) with multiple medical comorbidities
were treated with the above protocol. The average time to complete vascularization
of the matrix was 29 days. Definitive closure with split-thickness skin graft was
achieved in three patients and one wound healed by secondary intention. No medical
or surgical complications were encountered and stable soft tissue coverage was achieved
in all patients. This early experience suggests that dermal substitute and NPWT with
delayed skin graft application can provide a reasonable tissue-engineered alternative
to free tissue transfer in the medically compromised individual.
Keywords
acellular - dermal - matrix - lower - extremity
