Point-Counterpoint: Are Acellular Dermal Matrices More Effective Than Fibroblast-Derived Dermal Substitutes?
Yes. Citing the literature, enhanced sterility and ease of use, Howard Kimmel, DPM, says human acellular dermal matrices are an effective option for wound care.
No. Alexander Reyzelman, DPM, says the role that fibroblasts play in facilitating the healing of chronic wounds is well established whereas questions abound for acellular dermal matrices, which lack high-quality supporting evidence.
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The statistics are alarming. The morbidity and mortality associated with lower extremity wounds are high, and we are constantly exposed to new options to help heal our patients. The toolbox for the wound care clinician has expanded exponentially in the past decade and it seems as though we are learning more and more daily about the basic science behind wound care.
Surgical Pearls »
Both pediatric and adult-acquired flatfoot deformities, particularly posterior tibial tendon dysfunction (PTTD) stage II, remain difficult to treat and there is much controversy in regard to the optimal form of treatment. Patients usually present with increased pain and swelling along the medial aspect of the ankle or rearfoot. The foot generally maintains an abducted forefoot position and a decrease in the height of the medial longitudinal arch. Sometimes patients can perform a double heel raise but cannot perform a single heel raise. This signifies posterior tibial tendon pathology.