J Vet Clin 27(3) : 299-301 (2010)
299
Acellular Dermal Matrix for Wound with Large Dead Space in 3 Dogs
Kyoung-a Youp, Ye-Eun Byeon, Sun-Tae Lee, Hee-Jung Kim, Ji-young Cho, Oh-kyeong Kweon, Jin young Kim
*, Ke-Won Kang
*and Wan Hee Kim
1Department of Veterinary Surgery, College of Veterinary Medicine, Seoul National University, Seoul 151-742, Korea
*Hans Biomed Corporation, Daejeon 305-811, Korea (Accepted: May 27, 2010)
Abstract :An acellular human dermal matrix (ADM) was applied to wounds from dogs with significant dead space and delayed healing. This treatment is typically effective for the treatment of wounds with subcutaneous dead space and injuries between muscular planes. The size of the dead space defect and the amount of wound discharge decreased rapidly with ADM treatment in the present study. The average time to disappearance of the dead space defect was 10 days. In addition, complications including severe inflammation were not seen in this case report.
Key words :Acellular human dermal matrix (ADM), dead space, dogs, wound healing.
Introduction
Surgical closure results in superior wound healing, particu- larly when it is performed soon after injury. However, primary wound closure is frequently not practical in wounds with large amounts of dead space. Wound factors including dead tissue and reactive inflammation may inhibit natural healing, and the replacement of missing tissue is imperative in healing (7).
Elimination of dead space promotes early union of divided tis- sues (2). Several biosynthetic materials are currently under eval- uation which could aid in the elimination of dead space (7), including Acellular Dermal Matrix (ADM), which is derived from human cadaver skin. ADM is effective in the treatment of full-thickness burns in human burn victims. It also functions as a substrate material for oral resurfacing and periodontics, a soft-tissue filler in plastic surgery, a dural replacement in spi- nal cord injury, and as an adjunct tissue treatment in the repair of recurrent umbilical and ventral hernias, closure of gyneco- logic wounds, and coverage of exposed joints (1,4,5,7,8).
ADM (Sheba®, Hans Biomed, Korea) was applied to wounds with large amount of dead space and delayed healing in 3 dogs in the present study. Bandages were changed daily; mea- surement of dead space defects and amount of wound dis- charge were noted for each patient. The application of ADM does not require anesthesia, is not invasive, and can promote healing of the entire wound.
Case
Case 1
A 8-year-old intact female Jindo Dog presented with a 2-
month history of moderate otitis externa in the left ear. Com- puted tomography (CT) of the skull revealed a soft tissue mass in the left horizontal ear canal with no changes in the tym- panic membrane or bullae. Amoxicillin and clavulanate (Cla- vamox®; Pfizer, 12.5 mg/kg orally BID) and serratiopeptidase (Danazin®; Skynewpharm, 0.25 mg/kg orally BID) were admin- istered for 10 days. A total ear canal ablation as well as a lat- eral bulla osteotomy were performed, and serosanguineous discharge was observed from the ear during the post-operative recovery periods. There was a diminished amount of discharge on the 14th post-operative day, but the size of the dead space defect was 9.13 cm2 (analyzed by the image tool software pro- gram, UTHSCSA, version 3.0). This measured value was very similar to that measured early in the post-operative period (Fig 1A). ADM was applied to the defect, and the dead space defect closed on the 12th day after ADM application (Fig 1B).
Case 2
A 5-year-old intact male Golden Retriever was presented for treatment of a left elbow pressure sore. An axial pattern flap of the left foreleg had been performed 18 months prior to presentation. A round wound with mucopurulent discharge (4 cm diameter) was noted on physical examination, and was diagnosed as a grade II pressure sore. Ciprofloxacin (Ciprof- loxacin HCl®; Chungwae, 5 mg/kg orally BID) was adminis- tered and a wet-to-dry bandage was applied. A left elbow advancement flap was performed 10 days after initial presen- tation. The flap was lengthened to cover the entire wound to eliminate tension, and tacking sutures were applied. How- ever, dehiscence was identified at the surgical site 5 days post-operatively. A compressive bandage was applied, but the dead space defect enlarged (8.4 cm2) and the amount of dis- charge increased. ADM applied to the dead space on the 9th post-operative day (Fig 2A). The dead space defect disap-
1Corresponding author.
E-mail: [email protected]
300 Kyoung-a Youp et al.
peared 7 days after ADM application (Fig 2B).
Case 3
A 2-year-old intact female Boxer was presented with swelling and heat of the right hind leg, pubic region, and vulva. The dog had a clinical history of recent dog bites in the area which were sutured at a local veterinary hospital. The wound demonstrated evidence of cellulitis and infection. The right hind limb was swollen to 1.5 times greater than the left hind limb, and dead space from the skin defect to the distal femur. The dog had a normal gait on orthopedic examination.
A direct impression smear of the wound was performed and revealed numerous cocci and white blood cells. The wound was lavaged with 0.9% normal saline and bandaged twice daily. Cefadroxil (Cefadroxil®; Hawon, 22 mg/kg orally BID) and serratiopeptidase (Danazin®; Skynewpharm, 0.25 mg/kg orally BID) were administered for 14 days. Abnormal heat, right hind leg swelling, and serous discharge were improved at the one-week recheck. Bacteria were not identified on cyto- logical examination of the serous discharge. However, there was no improvement in the size of the dead space defect
(55.8 cm2), as seen in Fig 3A. ADM was applied to the deep- est anatomic regions of the dead space defect. Bandages were changed daily. The size of the dead space defect was 19.8 cm2 on the 6th day after ADM application; however, healing was delayed. ADM was applied to the defect again on the 6th day.
The skin wound was almost completely healed by granula- tion and epithelialization 4 days later, and the size of the dead space defect was 14.3 cm2 (Fig 3B). The wound was com- pletely healed 3 months after the last examination.
Discussion
Lavage and bandage procedures have usually been used to treat large defect wounds which cannot be closed by primary sutures (2,7). However, bandages and lavage procedures were not adequate to resolve the dead space defects in the present study. ADM application resulted in rapid dermal wound heal- ing in the present study. ADM is potentially useful for the treatment of subcutaneous wound dead space defects and mus- cular plane injuries. ADM contains growth factors, proteins, hormones, antibodies, antigens, and DNA; these substances
Fig 1. Case 1 after TECA/LBO surgery. (A) The size of the dead space defect was 9.13 cm2, and ADM was applied to the defect (Day 1). (B) The dead space defect size and amount of discharge diminished by Day 12 (Scale bar: 1 cm).
Fig 2. Case 2 after the left elbow advancement flap. (A) The size of the dead space defect was 8.4 cm2, and ADM was applied to the defect (Day 1). (B) The dead space defect size diminished by Day 7 (Scale bar: 1 cm).
Acellular Dermal Matrix for Wound with Large Dead Space in 3 Dogs 301
promote migration, proliferation, and differentiation of resi- dent cells, restoring function to injured tissues (3,6).
Xenografts are transplantation materials derived from genet- ically different species. Immune responses to xenografts include both natural and induced humoral components (7). However, such responses can be circumvented by the use of acellular and avascular tissues or purified connective tissue matrices (4,7). ADM is produced through the elimination of cellular components in dermis inducing immune responses and rejec- tion. A freeze-drying process allows ADM to be produced without altering the structures of collagen, elastin, and lami- nin of bioactive proteins in natural tissue (7). Complications including severe inflammation were not seen in this case report.
References
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3. Jimenez AP. Tissue and cellular approaches to wound repair.
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4. Johnson MJ. Onlay hiatal reinforcement utilizing human acellular dermal matrix. Surgical Innovation 2005; 12: 239-241.
5. Maurice MS. Use of human dermal matrix for abdominal wall reconstructions. Am J surgery 2009; 197: 35-42 6. Qui QQ. Evaluation of bone regeneration at critical-sized
calvarial defect by DBM/AM composite. J Biomed Master Res B Appl Biomater 2006; 10: 516-523.
7. Ruszczak Z. Effect of collagen matrices on dermal wound healing. Advanced Drug Delivery Reviews 2003; 55: 1596- 1611.
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개의 큰 사강을 갖는 창상에서 무세포성 진피기질의 적용 3례
엽경아·변예은·이선태·김희정·조지영, 권오경·김진영*·강계원*·김완희1 서울대학교 수의과대학, *한스 바이오메드
요 약 :광범위한사강과함께치유가지연된개의창상에무세포성진피기질(Acellular human dermal matrix, ADM)을 적용하였다. 이치료는 피하 사강을 갖는 창상과 근육면 사이의 창상에 특히 효과적인 치료법이었다. 본증례에서 ADM 적용시사강의크기와삼출물의양이급격히줄어들었다. 사강이사라지는 데까지의평균기간은약 10일이었 다. 또한, 이증례에서는중증의 염증과같은복합증은확인되지않았다.
주요어 :무세포성 진피기질(ADM), 사강, 개, 창상 치유
Fig 3. (A) The dead space defect was 55.8 cm2 for the patient in Case 3. ADM was applied to the dead space defect (Day 1). (B) The size of the dead space defect was 14.3 cm2 on Day 10 (Scale bar: 1 cm).
