title: Wound healing in the upper and lower extremities:  a systematic review on the use of acellular dermal matrices.
abstract: BACKGROUND
  Use of biologically engineered acellular dermal matrices in the upper and lower extremities is increasingly recognized as a means of achieving definitive healing in the setting of both acute and chronic injuries but data and evidence supporting their use are limited. The authors performed this systematic review to identify all available evidence for the use of matrices in nonburn extremity reconstruction.
  
  
  METHODS
  A systematic review of the Cochrane and MEDLINE databases was performed to identify all reports of the application of matrices in wounds of the upper and lower extremities. Reports that included fewer than five patients and that involved cellular seeding, nonhuman 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 the American Society of Plastic Surgeons' Rating Levels of Evidence.
  
  
  RESULTS
  Of an initial 2422 reports, 13 primary reports were identified (10 case series and three randomized controlled trials) representing a total of 432 patients and 441 discrete wounds. After evidence review, 10 of these studies represented level IV evidence, two studies represented level II evidence, and one study achieved level I evidence.
  
  
  CONCLUSIONS
  Extremity wound management continues to rely on adequate vascular supply, débridement with eradication of infection, off-loading, and/or immobilization. Current data, although limited, appear to support the use of acellular dermal matrices in chronic and acute injuries where there is exposed bone, tendon, and/or muscle. They may provide a simple technique to achieve timely and durable tissue coverage in extremity wounds.
authors.affiliation: Washington, D.C. From the Department of Plastic Surgery, Georgetown University Hospital.
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Iorio
authors.forename: John
authors.initials: J
authors.lastname: Shuck
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
mesh_terms: D062088:Acellular Dermis; D001132:Arm / Q000601:surgery*; D001134:Arm Injuries / Q000601:surgery; D002809:Chondroitin Sulfates; D002908:Chronic Disease; D003094:Collagen; D019317:Evidence-Based Medicine; D006801:Humans; D007866:Leg / Q000601:surgery*; D007869:Leg Injuries / Q000601:surgery; D007871:Leg Ulcer / Q000601:surgery; D018482:Muscle, Skeletal / Q000293:injuries / Q000601:surgery; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D017768:Skin, Artificial; D017695:Soft Tissue Injuries / Q000601:surgery; D013708:Tendon Injuries / Q000601:surgery; D054457:Tissue Scaffolds; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: C114835:integra artificial skin; D002809:Chondroitin Sulfates; D003094:Collagen