Tognetti Linda, Pianigiani Elisa, Ierardi Francesca, Lorenzini Guido, Casella Donato, Liso Flavio Giulio, De Pascalis Andrea, Cinotti Elisa, Rubegni Pietro
Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.
Department of Odontostomatologic and Ophthalmologic Sciences, University of Siena, Siena, Italy.
Dermatol Ther. 2021 Jul;34(4):e14987. doi: 10.1111/dth.14987. Epub 2021 May 24.
Wound closure after post-traumatic injuries and/or localized at peculiar body sites (head-and-neck, oral cavity, legs) are particularly challenging and can often be delayed due to local and systemic factors. In case of deep wounds and/or hard-to-heal wounds, grafting of dermal acellular matrices (ADM) is often needed. Though a great variety of synthetic and semisynthetic dermal and skin equivalents are available, viable human dermis, is still considered the most physiological alternative to replace the loss of autologous dermis, by acting as a physiological scaffold that add structural support to soft tissues. To date, human ADMs (hADMs) have been employed in the reconstruction of skin defects affecting almost all body sites, ranging from visceral sites to the skin and subcutaneous tissues. This review aims to investigate the use of hADM at different body sites and their peculiar advantages. A literature search was using the search terms "acellular dermal matrices", "dermal regeneration", "advances wound healing", "human acellular dermal matrices surgery". A total of 50 out of 150 papers was included. Based on the current body if evidence, hADMs appear to bring several advantages, such as: protection of deep structures (eg, tendons, bones, cartilage and nerves); stimulation of a functional new dermis (rather than a scar); reduction of wound closure time; control of pain and exudate. Finally, hADMs may represent the best treatment option for hard-to-heal wound not only in terms of efficacy and patient satisfaction bout also in terms of sanitary costs, especially across Europe, where hADMs cannot be commercialized as medical devices.
创伤后伤口闭合以及/或者发生在特殊身体部位（头颈部、口腔、腿部）的伤口闭合尤其具有挑战性，并且常常会由于局部和全身因素而延迟。对于深部伤口和/或难愈合伤口，通常需要移植脱细胞真皮基质（ADM）。尽管有各种各样的合成和半合成真皮及皮肤替代物，但有活力的人真皮仍被认为是替代自体真皮缺失的最接近生理状态的选择，它可作为一种生理支架，为软组织提供结构支撑。迄今为止，人ADM（hADM）已被用于几乎所有身体部位皮肤缺损的重建，从内脏部位到皮肤和皮下组织。本综述旨在研究hADM在不同身体部位的应用及其独特优势。通过使用搜索词“脱细胞真皮基质”“真皮再生”“促进伤口愈合”“人脱细胞真皮基质手术”进行文献检索。150篇论文中共有50篇被纳入。基于目前的证据，hADM似乎具有多种优势，例如：保护深部结构（如肌腱、骨骼、软骨和神经）；刺激形成功能性新真皮（而非瘢痕）；缩短伤口闭合时间；控制疼痛和渗出液。最后，hADM可能是难愈合伤口的最佳治疗选择，不仅在疗效和患者满意度方面，而且在卫生成本方面，特别是在欧洲，在那里hADM不能作为医疗器械商业化。
