Biological incorporation of human acellular dermal matrix used in Achilles tendon repair
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Biological incorporation of human acellular dermal matrix used in Achilles tendon repair Giampietro Bertasi . Windy Cole . Brian Samsell . Xiaofei Qin . Mark Moore
Received: 13 January 2017 / Accepted: 18 April 2017 Ó The Author(s) 2017. This article is an open access publication
Abstract Human acellular dermal matrices (ADMs) are used successfully in a variety of procedures, including sports medicine related, wound repair, and breast reconstructions, but the mechanism of repair is still not fully understood. An opportunity to explore this mechanism presented itself when a patient experienced a rerupture of the native tendon due to a fall that occurred 2 months after undergoing an Achilles tendon repair using Matracell treated ADM. The ADM was removed and an extensive histology analysis was performed on the tissue. Additionally, a literature review was conducted to determine the mechanism of ADM integration into the tendon structure and explore if differences in this mechanism exist for different types of human ADMS. The histology analysis demonstrated that the healing process during a tendon reconstruction procedure is similar to that of wound healing. Furthermore, the literature review showed that differences exist in the mechanism for integration among various human
G. Bertasi (&) University of Padua, Padua, Italy e-mail: [email protected] W. Cole Robinson Wound Care Center, 1533 South Water Street, Kent, OH 44240, USA B. Samsell X. Qin M. Moore LifeNet Health, 1864 Concert Drive, Virginia Beach, VA 23453, USA
ADMs and that these differences may be due to variances in the methods and technologies that manufactures use to process human ADMs. Keywords Acellular dermal matrix ADM Allograft Matracell Tendon augmentation Histology
Introduction The use of matrix-derived biologic scaffolds has become a frequently used option in a variety of clinical applications though not all matrix types respond similarly. Xenografts may still contain alpha-gal, an epitope not present in humans, even after decellularization, leading to negative interactions with human anti-alpha-gal-antibodies (Galili 1993, 2001). Furthermore, there have been potential immunogenic issues noted with decellularized porcine small intestine submucosa (SIS) (Bellows et al. 2006; Zheng et al. 2005), even leading some surgeons to discontinue xenograft SIS use (Iannotti et al. 2006). Synthetic matrices, another option, can be difficult to create with the same make-up and orientation as naturally occurring extracellular matrices (Cheng et al. 2014). In contrast, human ADMs have been successfully used in a wide variety of procedures including wound healing, soft tissue repair, and sports medicine applications (Bullocks 2014; Levenda and Sanders 2015; Walters et al. 2016). Theoretically, the decellularization
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process removes potentially immunogenic cellular constituents yielding a biocompatible scaffold that can be integrated by host cells (Norton and Babenesee 2009). However, there are differences at the cellular leve
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