title: Single-institution outcome experience using AlloDerm® as temporary coverage or definitive reconstruction for cutaneous and soft tissue malignancy defects.
abstract: Definitive reconstruction after excision of cutaneous and soft tissue malignancies is sometimes limited as a result of lack of native tissue coverage options, patient comorbidities, or pending permanent margin analysis. Acellular dermis (AlloDerm®) reconstruction offers an excellent coverage alternative in these situations. We describe our experience using AlloDerm for coverage of skin and soft tissue defects. An Institutional Review Board approved review of patients undergoing skin/soft tissue coverage with AlloDerm from 2006 to 2012 was performed. Clinicopathologic variables, early postoperative findings, and subjective final cosmetic outcome were analyzed. Sixty-seven patients underwent AlloDerm reconstruction. Melanoma (67%) was the most frequent diagnosis. The median defect size was 42 cm(2) (range, 2 to 340 cm(2)), involving predominantly the lower extremity (45%) or head and neck (32%). AlloDerm was intended for use as a temporary dressing in 64 per cent (43 of 67) and permanent coverage in 24 (36%). Ten patients required reexcision for positive margins. Twenty-five (37%) underwent split-thickness skin graft or flap coverage after AlloDerm placement. Radiation was administered to 16 patients (24%) after AlloDerm reconstruction within a median of 53 days after surgery (range, 18 to 118 days). At first postoperative examination (median, 11 days after surgery), 85 per cent had evidence of healthy AlloDerm incorporation. Cellulitis was the most frequent complication (13%), all resolving with oral antibiotics. AlloDerm reconstruction after skin and soft tissue resection offers a suitable coverage alternative and may serve as a bridge to permanent reconstruction or as a permanent biologic dressing of complex surgical defects. In situations in which adjuvant radiation is needed, AlloDerm can be used without major complications.
authors: Department of Cutaneous Oncology, Moffitt Cancer Center, Tampa, FL 33612, USA.
authors: Jeremiah L
authors: JL
authors: Deneve
authors: Kiran K
authors: KK
authors: Turaga
authors: Suroosh S
authors: SS
authors: Marzban
authors: Christopher A
authors: CA
authors: Puleo
authors: Amod A
authors: AA
authors: Sarnaik
authors: Ricardo J
authors: RJ
authors: Gonzalez
authors: Vernon K
authors: VK
authors: Sondak
authors: Jonathan S
authors: JS
authors: Zager
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000601:surgery; D002481:Cellulitis / Q000453:epidemiology / Q000209:etiology; D003094:Collagen; D018223:Dermatofibrosarcoma / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000601:surgery*; D016038:Skin Transplantation; D012983:Soft Tissue Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D016896:Treatment Outcome; D014945:Wound Healing
chemical_list: C440568:Alloderm; D003094:Collagen
references: Transplantation. 1995 Jul 15;60(1):1-9
references: 7542811
references: Arch Facial Plast Surg. 2003 Jan-Feb;5(1):40-4; discussion 45
references: 12533137
references: J Craniofac Surg. 2010 Mar;21(2):605-7
references: 20489465
references: Ann Surg Oncol. 2008 Jun;15(6):1733-40
references: 18379848
references: Otolaryngol Head Neck Surg. 2000 Feb;122(2):189-94
references: 10652388
references: Plast Reconstr Surg. 2005 Apr;115(4):1010-7
references: 15793438
references: JSLS. 2006 Jan-Mar;10(1):83-5
references: 16709366
references: Neurosurgery. 2000 Jun;46(6):1391-6
references: 10834644
references: Arch Otolaryngol Head Neck Surg. 1998 Nov;124(11):1201-4
references: 9821920
references: Plast Reconstr Surg. 1999 Jun;103(7):1902-8
references: 10359252
references: Dermatol Surg. 2009 Apr;35(4):692-8
references: 19415797
references: J Burn Care Rehabil. 1996 Mar-Apr;17(2):124-36
references: 8675502
references: Dermatol Surg. 2011 Apr;37(4):527-9
references: 21388485
references: Ann Plast Surg. 2005 Sep;55(3):232-9
references: 16106158
references: Ann Plast Surg. 2004 Feb;52(2):188-94
references: 14745271
references: Burns. 2010 May;36(3):322-8
references: 20080353
references: J Craniofac Surg. 2008 Nov;19(6):1660-2
references: 19098576