Tissue Augmentation and Replacement of a Heel Fat Pad With a Decellularized Sterile Human Dermal Matrix
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Index: WOUNDS. 2012;24(7):185–189.
Abstract: The use of xenografts and allografts has been primarily directed at chronic wounds and tendon repair. Currently, there are no known devices in this category that can successfully be used to augment tissue. Patients who have undergone trauma and subsequent surgery, particularly in weight-bearing areas, may experience pain with pressure or ambulation at the site. This report illustrates the use of an allograft for tissue augmentation in a young individual who was involved in a motor vehicle accident resulting in loss of the plantar fat pad. An allograft was successfully used for tissue replacement, thereby reducing pain and facilitating weight-bearing ambulation.
Injuries to the skin, particularly in cases of trauma, may result in physical abnormalities that may affect a patient’s quality of life, be cosmetically unacceptable, and contribute to facilitated tissue breakdown. Plastic surgical reconstruction may partially address the defect but often involves procedures that are cosmetically unappealing to the patient or may leave areas with deficient underlying tissue.1 For example, the plantar aspect of the foot, when severely traumatized, may result in scarring, contracture, and increased pain when ambulating, particularly when the fat pad has been damaged or is no longer present. While tissue defects in other corporal locations, including the breast, hip, and buttocks, may pose problems specific to those locations, damage to the heel fat pad directly affects the individual’s ability to ambulate, because cushioning is no longer present. Pain with repetitive pressure to the plantar aspect of the foot further contributes to decreased ambulation. Augmentation of the heel pad with a collagen matrix is one method of addressing this issue.2
The following case presentation (Case 1) addresses near complete loss of the plantar heel fat pad subsequent to a motor vehicle accident. Tissue augmentation was performed with a novel, decellularized, sterile human dermal matrix. Two other patients who were treated in a similar fashion with similar results are presented in Case 2 and Case 3.
Decellularized human skin has been used for a variety of medical procedures, primarily, wound healing, soft tissue reconstruction, and sports medicine applications.3–22 In theory, decellularization serves to remove DNA material and provides a clean scaffold for host cellular and vascular ingrowth. Repair of rotator cuff tears is one of several reported clinical applications.2–8 During these procedures, the dermal matrix is typically used to augment a repair procedure in order to provide biomechanical strength, as well as to support directed healing. Similarly, Achilles and quadriceps tendon augmentation procedures using decellularized human skin are reported.9–12 Soft tissue reconstruction procedures are commonly performed with decellularized human skin, including primary, staged, and revision breast reconstruction.13–15 In addition, hernia repair using similar materials has been reported.16–19 Decellularized human skin is also widely used in the treatment of skin wounds, such as diabetic foot ulcers.20–22
A new, decellularized dermal allograft (DDA) has recently been introduced (DermACELL™, [LifeNet Health, Virginia Beach, VA]). The patented23 process used to prepare the DDA includes the use of anionic detergents and endonuclease, resulting in a material with more than 97% nucleic acid removal and acellular histological appearance.