Biomedical Engineering Reference
In-Depth Information
10
Human-derived acellular matrices for dermal
replacement
C. T. WAGNER, R. T. OWENS, J. R. HARPER
D. J. McQUILLAN
LifeCell Corporation, USA
and
Abstract:
AlloDerm, an acellular extracellular matrix (ECM) scaffold
derived from cadaveric dermal tissue, was introduced in 1994 principally as a
treatment for full-thickness burns. Since then, application of this regenerative
tissue matrix (RTM) has been expanded to hernia repair, breast reconstruc-
tion and gingival grafting. This technology platform has also been extended
to produce products for urogynecologic, orthopaedic, podiatric and
laryngologic indications. Through this broad range of applications, over a
million grafts have been used clinically with an exceptional satisfaction and
safety record. Recognition of the RTM's ability to support the regeneration of
cellular and vascularized soft tissue and the transition to a tissue architecture
resembling that specific to the treated site has fueled use by clinicians for new
and challenging indications.
Key words:
extracellular matrix (ECM), regenerative tissue matrix (RTM),
acellular.
10.1 Introduction
This chapter will focus on the use of acellular dermal RTM scaffolds for replacement,
repair, and regeneration of soft tissue deficits with emphasis on treating skin
dysfunction and loss. The overarching rationale for and function of RTMs will be
presented in the context of biochemical and mechanical characteristics believed to
facilitate a regenerative response rather than a common fibrotic scar repair process.
The significance of a properly prepared and intact ECM to support the body's
intrinsic regenerative abilities will be demonstrated through
in vitro
, preclinical
in
vivo
and clinical analyses. Moreover, the universality and value of this approach will
be shown by highlighting its employment in multiple clinical applications targeting
various tissue types and by its applicability to various tissues as RTM sources.
10.1.1 The problem
Skin, the largest organ of the body, is a dynamic layered composite comprising the
epidermis, dermis and hypodermis (anatomy and function reviewed in Fore, 2006;
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