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BACKGROUND:
Extremity wounds present a unique challenge based on biomechanical needs, and in many cases, attendant medical pathophysiology. The application of biologically engineered acellular dermal matrices in the upper and lower extremities is increasingly recognized as a means of achieving definitive healing, both in the setting of acute and chronic injuries. However, there is only limited available data and evidence supporting their use. The authors performed this systematic review to identify all available evidence for the use of acellular dermal matrices in non-burn extremity reconstruction.
METHODS:
A systematic review of the Cochrane and MEDLINE databases was performed to identify all reports of the application of acellular dermal matrices in wounds of the upper and lower extremities. Reports that included less than 5 patients, involved cellular seeding, non-human studies and burn injuries were excluded. Studies were evaluated for quality of statistical measures and outcomes, and a level of evidence was assigned in accordance with ASPS Rating Levels of Evidence.
RESULTS:
Of an initial 2,422 reports, a total of 13 primary reports were identified. These were comprised of 10 case series and 3 randomized controlled trials, which represented a total of 432 patients and 441 discrete wounds. Following evidence review, 10 of these studies represented level 4 evidence, 2 studies represented level 2 evidence, and 1 study achieved level 1 evidence.
CONCLUSIONS:
Extremity wound management continues to rely on adequate vascular supply, debridement with eradication of infection, off-loading and/or immobilization. Current data, although limited, appears to support the use of acellular dermal matrices in chronic and acute injuries where there is exposed bone, tendon, and/or muscle. Despite the need for continued evaluation and review of indications and outcomes, these matrices may provide a simple technique to achieve timely and durable tissue coverage in wounds of the extremities. At this time, the primary risk is graft failure, with a resultant need for alternative methods of closure. Secondary risks include seroma formation and rates of local infection similar to those of local wound care.