Could A New Acellular Matrix Lead To Better Outcomes In Wound Healing And Tendon Coverage?

Podiatry Today Staff

For those looking for an alternative acellular dermal matrix, which can facilitate wound healing and be beneficial in procedures requiring tendon coverage, one may want to consider the DermaSpan Acellular Dermal Matrix.

   DermaSpan is a collagen matrix allograft, which is manufactured from donated human skin allograft with no cellular elements present, according to the manufacturer Biomet Sports Medicine. The company says the allograft undergoes aseptic cleaning that removes cellular components. Biomet notes that having a collagen scaffold without cellular components significantly reduces immunogenicity while simultaneously making the scaffold available for host-cell remodeling into the graft.

   Kyle Kinmon, DPM, MS, FACFAS, says the sterile nature of DermaSpan is a key benefit.

   “Clinically, I have seen no inflammatory response with DermaSpan relative to other acellular dermal matrices that I have used in the past,” notes Dr. Kinmon, who has used DermaSpan for the past five to six months in the OR setting. “This is likely due to the fact that DermaSpan is supplied sterile whereas others are not. The thinner sizes (as thin as 0.5 mm) with maintained tensile strength available in DermaSpan also lead to more successful applications, both in wound healing and tendon augmentation.”

   Biomet says physicians may use DermaSpan for the repair or replacement of damaged or inadequate integumental tissue. Surgeons can also use DermaSpan for supplemental support, protection, reinforcement or covering of tendon, according to the company.

   Dr. Kinmon says he has primarily used DermaSpan for wound healing applications but has also used it for tendon repair/augmentation. Dr. Kinmon believes the sterile nature of DermaSpan reduces the risk of complications.

   “My greatest concern for complication, based on experience with the use of other acellular dermal matrices and related products, is inflammatory reaction and infection leading to dehiscence, etc.,” notes Dr. Kinmon, who is board-certified in foot surgery and reconstructive rearfoot and ankle surgery by the American Board of Podiatric Surgery.

   “This can be devastating, especially in the case of Achilles repair/augmentation. To date, I have seen no signs of any inflammatory reaction or infection related to the use of DermaSpan. Again, I attribute this notable improvement over similar products primarily to the fact that DermaSpan is supplied sterile.”

   Biomet says the DermaSpan matrix acts as a scaffold, which host cells can penetrate and remodel the allograft, ultimately replacing it with healthy tissue.

   Dr. Kinmon, who is in private practice in Boca Raton, Fla., cites a case in which the use of DermaSpan made a significant difference. For a patient with diabetes, Dr. Kinmon used DermaSpan to augment the repair of a neglected retracted Achilles tendon rupture and reconstruct the posterior ankle joint capsule with soft tissue anchors without complication.

   “I would not have felt comfortable implanting a non-sterile product for such a deep, involved application,” notes Dr. Kinmon.

   In regard to Achilles and peroneal repair/augmentation, Dr. Kinmon advises using the least amount of the thinnest graft required to restore integrity to the repair site. He notes that excess material leads to tightness of the skin closure.

   As with any soft tissue graft or skin substitute, one should not use DermaSpan in the presence of infection or ischemia, according to Dr. Kinmon. He also notes proper offloading principles are essential in order to maximize the graft’s potential.

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