Novel Use of Acellular Dermal Matrices (Alloderm) in Maxillofacial Trauma, Tumor & Reconstructive Surgery

ABSTRACT:

Utilization of acellular dermal matrices for the reconstruction of complex soft-tissue defects has expanded across multiple surgical specialties over the last 20 years, particularly in the plastic surgery/breast-reconstruction

In this study we present our experience utilizing acellular dermal matrices in the management of soft-tissue defects related to maxillofacial trauma and maxillofacial oncologic surgery. It is our belief that the utilization of acellular dermal matrices will prove to be a valuable armamentarium for the reconstructive maxillofacial surgeon when faced with challenging soft-tissue defects.

Patients and Methods:

The retrospective study was a review of patients who underwent surgical procedures with the use of alloderm for soft tissue defects at the University of Miami Oral and Maxillofacial Surgery Department during the period between 2010 and 2014. The study sample comprised of 17 patients. All patients had their soft tissue defect related to trauma or maxillofacial oncological surgery at our institution or other maxillofacial and reconstructive centers. The three main indications in this study that we will show the usefulness of alloderm are as follows. 1) Lip incompetence related to ablative surgery of the perioral region. 2) Atrophic scar revision related to soft tissue deficiency and fibrosis. 3) Dermal thinness related to titanium plate appearance through skin.

5 patients were treated with alloderm for lip incompetence. The main chief complaint among these patients was excessive drooling secondary to soft tissue loss from surgery and trauma. All procedures were preformed under general anesthesia.  Incision was placed on previous incision sites whenever applicable. Incision was made to the depth of obiculars oris and a plane dissected in this layer using tissue scissors. Once adequate dissection and undermine of tissue under the lip, good hemostasis was achieved with needle tip bovie.  At this point Alloderm is is rolled and tied with a 3.0 vicyrl suture to the proper thickness for the defect. The rolled alloderm is than placed and sutured with 4.0 vicyrl in position. The tissue is closed with 4.0 vicryl for deeps and 5.0 nylon for skin closure.  If dehiscence occurs, usually conservative treatment is all that is need for mucosal tissue to migrate over the wound.

5 patients were treated for atrophic scar revisions which included inverted scar formation and tracheotomy “tug” scars which due to the negative pressure inspiration causing the skin and fascial layers to be pulled into the defect.

Simple technique of fusiform shaped excision of atrophic scar and fibrous tissue followed by liberal undermining in the subdermal layer which allow for primary closure without tension. The alloderm is shaped and cut into the proper shape and placed in to the defect, sutured at the periphery and then closed with interrupted or horizontal mattress sutures.

7 patients were treated for dermal thinness related to ablative tumor surgery. These patients complained of the unaesthetic appearance of the titanium reconstruction plate through the skin.  In our practice majority of these patients had simultaneous avascular bone grafting, which added the effect of the alloderm acting as a membrane. Once the surgical bed is packed with bone, we add multiple layers of thick alloderm to add bulk. The alloderm is then sutured into place and the wound is closed in standard multiple layers.

Results:

We report satisfactory result with one case of dehiscence and infection (Lip revision). The alloderm was removed and the patient healed without any further complication.  All other patients healed well and with appropriate function and aesthetics

Conclusion:

In these case studies we demonstrate the versatility and usefulness of acellular dermal matrices (alloderm) for soft-tissue defects related to maxillofacial trauma and maxillofacial oncologic surgery.