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F. Levin, R.E. Turbin, P.D. Langer; Use of Acellular Human Dermal Matrix as a Skin Substitute for Large Periocular Cutaneous Defects . Invest. Ophthalmol. Vis. Sci. 2006;47(13):3774.
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To describe our experience using acellular human dermal matrix (AlloDermTM, Lifecell Corp., The Woodlands, TX) as a full–thickness skin substitute for large peri–orbital skin defects.
The clinical records of patients who received an acellular dermal allograft between November 2003 and October 2005 were reviewed, and their postoperative photographs analyzed. Clinical outcomes, including graft viability, patient acceptance, and postoperative appearance, were assessed and complications noted.
In total, five patients underwent the placement of an Alloderm periocular cutaneous graft. Due to the size of the defects, these patients were not ideal candidates for autologous skin grafts. Three patients had severe comorbid conditons making Alloderm an attractive alternative to skin grafting. Three patients received AlloDerm for reconstruction of large periorbital defects following excision of exensive skin cancer (two for basal carcinoma and one for squamous cell carcinoma). In two other patients, AlloDerm was used to repair large full–thickness skin defects after trauma. Postoperative follow–up ranged from one to 13 months. The area of graft placement characteristically retained a whitish hue for several weeks postoperatively, but successfully epithelialized in all patients. Alloderm was easy to handle and shape to the appropriate size, and effectively covered the defects until epithelium grew in from the edges to cover the graft. Post–operative photographs demonstrated acceptable cosmetic appearance after epithelialization was complete. No postoperative complications were noted.
Patients with large, full–thickness periorbital skin defects can present a reconstructive challenge. In patients for whom large full thickness skin grafts are either inappropriate or extremely difficult to perform, the use of Alloderm to cover a large cutaneous defect may be a viable option. AlloDerm has excellent healing properties, elicits minimal inflammation, and possesses virtually no risk of infectious transmission or immunologic rejection. Its ability to function as a permanent dermal transplant in full–thickness and deep partial thickness burns is well established; we believe that these same characteristics make it an ideal material for large, full–thickness periorbital skin grafting in situations where autologous skin grafting may be extremely difficult or hazardous to the patient.
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