(CS-034) The Use of Aseptically Processed Meshed Reticular Acellular Dermal Matrix as a Scaffolding to Support Flap Ingrowth in Soft Tissue Reconstruction

Krista Bauer, RN, WCC, OMS,; Kari Day, RN, BSN, WCC; Ashley Wardman, CPPM, Surgical LPN-C

Introduction: Flap mobilization and closure is the mainstay of treatment in soft tissue reconstruction. Successful outcomes are only achieved when there is adequate tissue for transfer. When there is a relative tissue deficiency needed procedures may become more challenging and complex such as free tissue transfer and outcomes may be compromised.

Aseptically processed meshed human reticular acellular dermal matrix (HR-ADM) is unique in that it comes from the reticular dermal layer that provides an open network structure to support tissue ingrowth and serve as a scaffolding. While these tissue forms are known to assist with soft tissue support for secondary healing or split thickness grafting, this dermal matrix may also be used to support flap transfer.

Methods: We present 5 cases of soft tissue reconstruction necrotizing where there was a paucity of tissue for flap transfer. (pressure ulcers, trunk: #3, Groin:#1, Scalp:#1). In all cases, local flap mobilization was performed. Aseptically processed meshed human reticular acellular dermal matrix (HR-ADM) was placed prior to flap inset to serve as a scaffolding to support tissue ingrowth following flap transfer.

Results: In all 5 cases, the patients achieve complete closure, without the need for additional flap mobilization or free tissue transfer. Two patients resulted in an incisional dehiscence where the HR-ADM mesh was visualized and noted to be adherent and incorporated. Both patients underwent secondary closure without incident.

Discussion: Meshed HR-ADM has properties that allow tissue integration and incorporation. Patients with soft tissue deficits requiring flap reconstruction may benefit from meshed HR-ADM for additional support. While distant flaps and free tissue transfer are still considered the standard of care, these procedures may carry a higher risk of complications and or failure. The use of HR-ADM in these patients may help create a scaffolding for tissue ingrowth to help support flap transfer.