Composite Tissue Transfer for the Reconstruction of Multiple Tissue Defects of the Lower

Acellular Human Dermis (Alloderm) as an Adjunct to Plastic Surgical Reconstruction

Daniel A. Medalie, MD

Purpose: Acellular human cadaver dermis (Alloderm) is composed of the dermal elements of skin without any of the cellular elements. It was originally marketed solely as an adjunct to skin grafting procedures but has now been found to have multiple other applications. This poster is designed to explore the varied uses for the tissue.

Methods: The author utilizing Alloderm for a variety of different problems has performed multiple reconstructive surgeries. The alloderm has been used as an adjunct to skin grafting, a permanent filler, a fascial substitute in head and neck surgery and a fascial substitute in abdominal wall reconstruction.

Results: Case 1 involves the reconstruction of a forehead status-post total scalp avulsion and partially successful replantation. Alloderm overlaid with the patient’s skin was used to create a full thickness forehead reconstruction. Case 2 involves a man with a facial angiosarcoma and complete facial nerve resection. Alloderm was used in combination with free tissue transfer to close the defect and provide static suspension to the lip and nasal ala. Case 3 involves a women with a deeply depressed scar in the posterior calf. Alloderm was used as filler for the depression with excellent long-term contour. Case 4 involves a women with a massive (25 x30 cm) lower abdominal hernia s/p bilateral TRAM. She also had a splenectomy at a prior operation and was thus not a candidate for mesh reconstruction. Multiple pieces of thick Alloderm were sewn together to reconstruct her lower abdominal wall. An additional piece was used to fashion an internal “belt” to take tension off of the suture lines. The patient has had no hernia recurrence.

Conclusion: The uses of human acellular dermis extend beyond the skin. It’s utility in serving as a soft tissue filler and also fascial substitute make it an excellent alternative to prosthetic materials. Because it is human-derived, it does not appear to have the risk of infection associated with other material such as Gortex.

Case 1-Scalp replant with forehead necrosis Case 1 - Alloderm engrafted on forehead

Case 1-Skin graft on AllodermCase 1-Well healed forehead

Case 2-Sarcoma resection of face Case 2-Alloderm suspension of lip/cheek

Case 2-S/p flap with good maintenance of suspension

Case 3-Traumatic depressed scar Case 3- 12 months after Alloderm fill

Case 4- Massive hernia s/p bilateral TRAM Case 4- Hernia exposed

Case 4- Alloderm reconstruction of abdominal wall Case 4- 6 months post-op