A Novel Regenerative Tissue Matrix (RTM) Technology for Connective Tissue Reconstruction
Abstract: The restoration of structure, function, and physiology to damaged or missing tissue through the use of a regenerative tissue matrix (RTM) leads to regenerative healing rather than reparative scarring. While many processes exist to transform biologic materials into an extracellular matrix (ECM), only those that maintain the required structural and biochemical properties necessary to capture the intrinsic regenerative abilities of the body are suitable to produce an RTM. Histological examination using differential staining with hematoxylin and eosin stain or Verhoeff von Geisen stain of human biopsies of RTM obtained from 2 different abdominal surgery patients taken at 8- and 12 months were consistent with RTM remodeling into fascia-like tissue. A synopsis of recent studies on the use of the RTM GraftJacket® (Wright Medical Technologies, Memphis, Tenn) in successful closure of diabetic foot wounds is presented. Collectively, these reports indicate that LifeCell produced ECMs exemplified by GraftJacket exhibit the required clinical outcomes associated with an RTM.
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Cymetra: A Treatment Option for Refractory Ulcers
Abstract: Background: Cymetra? is a micronized, injectable form of AlloDerm® (LifeCell Corporation, Branchberg, New Jersey), an allogeneic dermal matrix product developed as a filler substance for cosmetic use. Recently, Cymetra has been reported to be effective in the healing of recalcitrant sinus tracts in two patients. Objective: The objective of the authors? study was to evaluate the safety and efficacy of Cymetra as an adjuvant in the treatment of a variety of chronic wounds. Methods: A retrospective chart review was performed for patients who were treated with Cymetra at the CURE Wound Care Center at the University of Miami, Miami, Florida. Results: Patients with various types of chronic ulcers, including pyoderma gangrenosum, eosinophilic fasciitis, chronic pressure ulcers, post-operative ulcers, venous insufficiency ulcers, and livedo vasculitis, were treated with Cymetra injections. All patients had refractory disease and failed to respond to prior treatments, which included Apligraf® (Organogenesis, Canton, Massachusetts), Dermagraft (Smith & Nephew, Largo, Florida), V.A.C.® Therapy? (KCI Inc., San Antonio, Texas), compression, etanercept, mycophenolate mofetil, prednisone, infliximab, cyclosporine, antibiotics, debridement, intralesional triamcinolone acetonide, and granulocyte/macrophage colony-stimulating factor (GMCSF). Of the 13 patients treated with Cymetra, nine patients? ulcers (69%) healed completely. Conclusions: Cymetra was well tolerated, and the majority of patients achieved complete healing of their ulcers after treatment.
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Negative Pressure Dressings: An Alternative to Free Tissue Transfers?
Abstract: Free tissue transfer is a well established tool for the reconstruction of large, complicated wounds of the extremities. However, when free flap reconstruction is contraindicated or in cases where it has failed, the management of this type of wound presents a formidable task. Although negative pressure wound therapy (NPWT) plays an increasing role in the treatment of complex open wounds, there are only a few reports of successful management of wounds with areas of exposed tendon or bone. The authors present their experience with the use of NPWT in the treatment of open wounds of the extremities with relatively large areas of exposed bone.
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Emerging Treatments in Diabetic Wound Care
Abstract: This paper reviews the physiology of wound healing and properties of the ?ideal? dressing and also reviews advanced wound therapeutics and dressings, such as growth factors and biological skin substitutes.
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Patient Opinion on Dermal Replacement Products
Abstract: Dermal replacement products are used frequently at St. Elizabeth?s Regional Burn and Wound Care Center to close full-thickness burns regardless of size. Patients with 20-percent total body surface area (TBSA) burns or less are given a choice between Integra? Artificial Skin (AFS) (Johnson and Johnson Medical, a Division of Ethicon, Arlington, Texas), AlloDerm® Acellular Tissue (ACT) (LifeCell Corporation, Branchburg, New Jersey), and autograft alone following a detailed description of the costs, benefits, and complications of each option. Burn patients with greater than 20-percent TBSA are not generally offered a choice, but it is not uncommon for such patients to have grafts from both products. To determine which dermal replacement product has higher patient satisfaction, a patient survey was conducted. Patients with less than 20-percent TBSA burn were interviewed via telephone regarding reasons they chose a particular product and about their satisfaction with the surgical results. Answers between patients receiving AFS and ACT grafts were then compared for differences. Patients with greater than 20-percent TBSA were interviewed via telephone in attempt to elicit a preference for one of the products. The authors found no significant difference in patient satisfaction between AFS and ACT. Some trends were found regarding factors influencing a patient?s choice. Cosmesis seemed to be more important to patients who chose AFS. Patients who chose ACT tended to be more concerned with the number of operations. There was a strong influence of medical personnel on graft choice with the physician being the strongest influence. No trends could be elicited for the patients with greater than 20-percent TBSA. Disclosures: Dr. Voigt has conducted research on Integra funded by Johnson and Johnson, has spoken on Integra at national meetings, and has received an honorarium from Johnson and Johnson. Dr. Voigt was hired to provide an instructional course on burn care to the sales staff of LifeCell, maker of AlloDerm, h
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