Point-Counterpoint: Are Acellular Dermal Matrices More Effective Than Fibroblast-Derived Dermal Substitutes?
- Volume 26 - Issue 5 - May 2013
- 9314 reads
- 1 comments
Dr. Kimmel is a Diplomate of the American Board of Podiatric Surgery. He is the Director of Residency Training at the Department of Veterans Affairs in Cleveland, Ohio. Dr. Kimmel is the Senior Clinical Instructor in the Department of Surgery at Case Western Reserve University School of Medicine in Cleveland.
1. Available at www.apligraf.com .
2. Lavery LA, Armstrong DG, Wunderlich RP, et al. Risk factors for foot infections in individuals with diabetes. Diabetes Care 2006;29(6):1288-1293.
3. FDA docket No. 97-484P. Available at http://www.fda.gov/ohrms/dockets/dailys/01/May01/050901/97n_484p-c000024... .
4. Association for the Advancement of Medical Instrumentation. Sterilization of health care products – general requirements for characterization of a sterilizing agent and the development, validation, and routine control of a sterilization process for medical devices. Standard 14937. 2000. Available at http://marketplace.aami.org/eseries/scriptcontent/docs/Preview Files/14937preview.pdf .
5. Marston WA, Hanft J, Norwood P, Pollak R, Dermagraft Diabetic Foot Ulcer Study Group. The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care. 2003;26(6):1701-5.
6. Veves A, Falanga V, Armstrong DG, Sabolinski ML, Apligraf Diabetic Foot Ulcer Study. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care. 2001;24(2):290-5.
7. Iorio ML, Shuck J, Attinger CE. Wound healing in the upper and lower extremities: a systematic review on the use of acellular dermal matrices. Plast Reconstr Surg. 2012; 130(5):232S–241S.
8. Brigido SA, Boc SF, Lopez RC. Effective management of major lower extremity wounds using an acellular regenerative tissue matrix: a pilot study. Orthopedics 2004; 27(Suppl 1):s145–49.
9. Brigido SA. The use of an acellular dermal regenerative tissue matrix in the treatment of lower extremity wounds: a prospective 16-week pilot study. Int Wound J 2006; 3(3):181–7.
10. Reyzelman A, Crews RT, Moore JC, et al. Clinical effectiveness of an acellular dermal regenerative tissue matrix compared to standard wound management in healing diabetic foot ulcers: a prospective, randomised, multicentre study. Int Wound J. 2009;6(3):196-208.
This author 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.
By Alexander Reyzelman, DPM
The field of bioengineered tissue has significantly expanded during the last decade. In addition to living skin substitutes, we now have access to many acellular dermal matrices. It is becoming more and more important to have a better understanding of the role these wound healing modalities play in our treatment armamentarium.
The success of fibroblast-derived dermal substitutes is based on the premise that there are living dermal fibroblasts seeded on to a scaffold, which one then applies to the wound. These living dermal fibroblasts are able to secrete growth factors, deposit matrix proteins and facilitate epithelial cell migration.
There are multiple reasons for the failure of the wound healing process but in order to understand how fibroblast-derived dermal substitutes may help, it is important to understand the role that fibroblasts play in the non-healed wound.