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Acellular Dermal Matrices in Reconstructive Pediatric Complex Lower Limb Trauma: An Observational Study
Oluwatobi Adegboye1, Kamlen Pillay, Saleigh Adams
1Author Affiliations: St Andrew's Anglia Ruskin (StAAR) Research Group, Faculty of Health, Education, Medicine, and Social Care, Anglia Ruskin University, Chelmsford, UK (Dr Adegboye); Division of Plastic and Reconstructive Surgery, Red Cross War Memorial Children's Hospital; and Division of Plastic & Reconstructive Surgery, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa (Dr Pillay and Prof Adams).
Insights
Acellular dermal matrices show promise for pediatric lower extremity trauma, especially when combined with negative pressure wound therapy. This approach may reduce complications like infections and scarring in children.
Area of Science:
- Regenerative Medicine
- Pediatric Surgery
- Wound Healing
Background:
- Acellular dermal matrices (ADMs) are established for adult lower extremity injuries.
- Limited data exists on ADM use in pediatric complex lower extremity trauma.
Purpose of the Study:
- To investigate the safety and efficacy of ADMs in children with complex lower extremity trauma.
- To evaluate ADM-related complications and the role of negative pressure wound therapy (NPWT).
Main Methods:
- Retrospective observational cohort study of 54 children treated with Pelnac™ ADMs.
- Data collected from 2010-2017 at a South African tertiary hospital.
- Primary outcome: ADM-related complications; Secondary outcome: NPWT usage.
Main Results:
- 45 of 54 children healed without complications.
- Nine children experienced complications, including acute loss (4), infections (3), hypertrophic scarring (5), and joint contractures (4).
- Patients receiving NPWT had fewer complications, particularly acute ADM loss.
Conclusions:
- ADM appears to be a safe and effective option for pediatric complex lower extremity trauma.
- Concomitant use of NPWT with ADMs may improve outcomes and reduce complications.
Background:
Contemporary research has shown that acellular dermal matrices can benefit adult lower extremity traumatic injuries; however, its use in children has not been explored.
Objective:
This study aims to explore the use of acellular dermal matrices in pediatric complex lower extremity trauma.
Methods:
This single-center retrospective observational cohort study of children with complex lower extremity trauma treated with Pelnac™, commercial acellular dermal matrices, was conducted at a tertiary hospital in South Africa from 2010 to 2017. Demographic and clinical data were collected from medical records. The primary outcome was the rate and type of acellular dermal matrices-related complications. Secondary outcomes included the usage of negative pressure wound therapy.
Results:
A total of 54 children were studied; 30 (55%) were male, and the median age was six. Forty-five children healed without complications, while nine experienced complications - four acute and five chronic. Four patients had complete loss of acellular dermal matrices, and three developed acute infections. More than 30 days post-acellular dermal matrices application, five patients had hypertrophic scarring, four had joint contractures, and two had non-healing wounds. All patients who healed without complication received negative pressure wound therapy (n = 45), while those who did not (n = 5) developed complications. Three of the five patients without negative pressure wound therapy had acute acellular dermal matrices loss, compared to only one of the 49 patients who received negative pressure wound therapy.
Conclusion:
Our findings suggest that acellular dermal matrices may be an effective and safe reconstructive adjunct or alternative when used with negative pressure wound therapy.
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