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PubMed2026

Improved donor-site biomechanics and functional recovery with xenogeneic acellular dermal matrix after ALT flap harvest: A prospective randomized controlled study.

BACKGROUND: Donor-site management after anterolateral thigh (ALT) flap harvest is a significant yet underaddressed concern in reconstructive surgery for oral cancer. While xenogeneic acellular dermal matrix (Xeno-ADM) is common in soft-tissue repair, its efficacy for fascia lata reconstruction at the ALT donor site remains insufficiently characterized. This study aimed to assess the efficacy of xeno-ADM in fascia lata repair, focusing on compartment pressure, inflammatory and muscle injury biomarkers, and functional recovery. METHODS: In this prospective, randomized, single-blind trial, 200 patients undergoing ALT flap reconstruction were allocated to Xeno-ADM repair (n = 100) or primary closure (n = 100). Primary endpoints included compartment pressure, inflammatory markers in drainage fluid, serum muscle injury biomarkers, and functional outcomes. RESULTS: The xeno-ADM group showed significantly lower compartment pressures throughout postoperative days (POD) 1-5. Inflammatory markers in drainage fluid (CRP on POD 3 and 5) and serum muscle injury biomarkers (creatine kinase on POD 1 and 5) were significantly lower in xeno-ADM group. Functional outcomes were superior in the Xeno-ADM group, with faster gait recovery, lower pain scores at POD 7, and better lower-limb function at the 1- and 6-month follow-ups. Drainage duration did not differ between groups. Stratified analyses revealed that the benefits of xeno-ADM were more pronounced in patients with defect width >3 cm or a body mass index ≥24 kg/m2. CONCLUSION: Xeno-ADM provides a safe and effective approach for fascia lata repair, reducing biomechanical and inflammatory burdens while enhancing functional recovery. These findings support a transition from simple structural closure toward functional donor-site reconstruction.

Humans↗

PubMedDate not supplied

A novel approach for intestinal elongation using acellular dermal matrix: an experimental study in rats.

We tested the hypothesis that an anatomic scaffold placed in continuity with viable bowel might allow intestinal growth. Male ACI rats were used for the study. Acellular human dermis in the form of tubular scaffolds with an intraluminal diameter of approximately 0.3 cm was oriented with the luminal basement membrane and serosal dermal surface. The small bowel was transected approximately 2 cm distal to the ligament of Treitz. The graft was then anastomosed in continuity in group A (n = 5) or as a blind-ended pouch to a defunctionalized jejunal limb in group B (n = 8). The animals were sacrificed at various time points. Histology and immunohistochemistry were used to evaluate structural changes. Animals in group A developed peritonitis and were all sacrificed within the first week postoperatively. However, all animals in group B survived, increasing their body weight similarly to age-matched rats. Tissue samples obtained at sacrifice showed a progressively increasing amount of cellular infiltrate over time in the matrix. Epithelial regeneration, angioneogenesis, and myofibroblast infiltrate were seen at 2 weeks, while well-formed branching crypts were seen at 4 weeks. Intact mucosa extended across the anastomosis to the grafts at 6 months. This study demonstrated an anatomic scaffold of acellular matrix allowed mucosal regeneration from viable bowel placed in continuity. These findings set the basis for new intestinal elongation techniques.

Anastomosis, Surgical↗

PubMed2006

Transperineal repair of persistent rectovaginal fistulas using an acellular cadaveric dermal graft (AlloDerm).

A number of surgical techniques have been described to treat rectovaginal fistulas. Recurrent or persistent fistulas after previous repair can be particularly difficult to treat. We report a novel technique used to successfully repair rectovaginal fistulas after failed mucosal advancement flap procedures using a transperineal-layered closure with an interposed graft of acellular cadaveric dermis (Alloderm).

Adult↗

PubMed2004

FGF-7 expression enhances the performance of bioengineered skin.

To improve the performance of bioengineered skin, we used a recombinant retrovirus encoding FGF-7 to modify diploid human keratinocytes genetically. Control or FGF-7-expressing keratinocytes were seeded onto acellular human dermis to form bioengineered skin. Gene-modified skin secreted significant levels of FGF-7 and formed a thicker and hyperproliferative epidermis with about four times the number of cells per square centimeter. Secretion of an endogenous trophic factor, VEGF, was increased approximately 5-fold. Migration of FGF-7-expressing keratinocytes was stimulated as was the self-healing of bioengineered skin expressing FGF-7. When tested in a bacterial infection model, the antimicrobial properties of FGF-7-expressing skin were increased >500-fold against both gram-negative and gram-positive bacteria. After transplantation to full-thickness wounds on athymic mice, skin expressing FGF-7 was revascularized more rapidly. These results demonstrate that genetic modification can be used to enhance performance and that expression of FGF-7 augments several properties important to the wound-healing properties of bioengineered skin.

Animals↗

PubMed1999

Ophthalmic plastic applications of acellular dermal allografts.

PURPOSE: Clinical problems of contracted conjunctival fornices, superior sulcus defects, and soft tissue contour defects in the periorbital region have not shown good, sustained results with a range of autologous and alloplastic implants. AlloDerm (Lifecell Corp., Woodlands, TX) is an acellular dermal graft processed from human donor tissue. The authors sought to assess the efficacy of AlloDerm as a soft tissue replacement in a variety of oculoplastic applications. DESIGN: Retrospective, noncomparative case series. PARTICIPANTS: Twenty-three patients. METHODS: Applications were broadly classified as barrier/scaffolding (i.e., primary and secondary implant coverage, lid spacer graft) and volume augmentation (i.e., superior sulcus and other periorbital soft tissue contour defects). Barrier grafts were applied as single sheets. Stacked sheets or rolled grafts were used for augmentation. Collectively, this material was used in 29 cases with 3 to 16 months' follow-up. MAIN OUTCOME MEASURES: Clinical evaluation of outcome and complications. RESULTS: As a soft tissue scaffolding and barrier implant, AlloDerm persisted sufficiently to permit repopulation with native tissue. Rolled/stacked implants demonstrated unpredictable resorption. Upper eyelid grafts seemed to have higher resorption rates than lower eyelid grafts. One case of anophthalmic superior sulcus augmentation required two revision surgeries to provide sufficient volume augmentation. The grafts were well tolerated, with no cases of infection or explanation. CONCLUSION: Acellular human dermis is an excellent barrier and reconstructive grafting material that provides an alternative to autologous grafts and other alloplastic material, avoids harvesting autologous tissue, possesses excellent handling properties, and is associated with minimal inflammation. Long-term follow-up is required to evaluate persistence.

Coated Materials, Biocompatible↗

PubMed2001

Initial experience with a composite autologous skin substitute.

Patients with large burns are surviving in increasing numbers, but there remains no durable and reliable permanent skin replacement. After initial favorable small animal experiments, a pilot trial of a composite skin replacement was performed in patients with massive burns. A composite skin replacement (CSR) was developed by culturing autologous keratinocytes on acellular allogenic dermis. This material was engrafted in patients with massive burns and compared to a matched wound covered with split thickness autograft. With human studies committee approval, 12 wounds in 7 patients were grafted with CSR while a matched control wound was covered with split thickness autograft. These 7 children had an average age of 6.4+/-1.4 yr and burn size of 75.9+/-5.0% of the body surface. Nine wounds were acute burns and three were reconstructive releases. Successful vascularization at 14 days averaged 45.7+/-14.2% (range 0-100%) in the study wounds and 98+/-1% (range 90-100%) in the control sites (P<0.05). Reduced CSR take seemed to correlate with wound colonization. All children survived. While CSR did not engraft with the reliability of standard autograft, this pilot experience is encouraging in that successful wound closure with this material is possible, if not yet dependable. It is hoped that a more mature epidermal layer may facilitate engraftment, and trials to explore this possibility are in progress.

Burns↗

PubMed2002

Prevention of burn wound conversion by allogeneic keratinocytes cultured on acellular xenodermis.

Deep dermal burns frequently tend to convert into full-thickness skin loss. We found that this wound deepening may be prevented by recombined human/pig skin (RHPS), consisting of human allogeneic keratinocytes cultured on acellular pig dermis. RHPS has skin-like consistency and therefore optimal adhesiveness to the wound. It can be easily removed from the dish and transferred to the recipient. The wound bed has to be prepared by tangential excision or deep dermabrasion to the level of capillary bleeding. RHPS has to be applied 'upside-down', with the epidermal layer facing the wound, to avoid the dermal matrix forming a barrier to the nutrients for the keratinocytes. In our practice, more than 70% of early excised or deeply dermabraded wounds grafted with RHPS healed in the course of one week after keratinocyte transplantation.

Journal Article↗

PubMedDate not supplied

Keratinocyte-driven contraction of reconstructed human skin.

We have previously reported that reconstructed human skin, using deepidermized acellular sterilized dermis and allogeneic keratinocytes and fibroblasts, significantly contracts in vitro. Contracture of split skin grafts in burns injuries remains a serious problem and this in vitro model provides an opportunity to study keratinocyte/mesenchymal cell interactions and cell interactions with extracted normal human dermis. The aim of this study was to investigate the nature of this in vitro contraction and explore several approaches to prevent or reduce contraction. Three different methodologies for sterilization of the dermal matrix were examined: glycerol, ethylene oxide and a combination of glycerol and ethylene oxide. While the nature of the sterilization technique influenced the extent of contraction and thinner dermal matrices contracted proportionately more than thicker matrices, in all cases contraction was driven by the keratinocytes with relatively little influence from the fibroblasts. The contraction of the underlying dermis did not represent any change in tissue mass but rather a reorganization of the dermis which was rapidly reversed (within minutes) when the epidermal layer was removed. Pharmacological approaches to block contraction showed forskolin and mannose-6-phosphate to be ineffective and ascorbic acid-2-phosphate to exacerbate contraction. However, Galardin, a matrix metalloproteinase inhibitor and keratinocyte conditioned media, both inhibited contraction.

Cell Count↗

PubMed1999

Advances in the management of lower eyelid retraction.

The purpose of this article is to describe the newer surgical techniques and materials available for repair of lower eyelid retraction. The anatomic basis, classification, and prevention of lower eyelid retraction are explored, as well as traditional methods of surgical management. Two case reports involving the successful use of acellular human dermis (AHD) for lower eyelid retraction are presented. Lower eyelid retraction is associated with a variety of etiologies, which mandate that the surgical repair be directed toward correction of the anatomic abnormality in each patient. Each surgical procedure and material used in the repair of eyelid retraction is associated with unique advantages and disadvantages. AHD has found multiple uses in oculoplastics, including reconstruction of the middle and posterior lamellae in eyelid retraction. An understanding of the mechanistic basis of lower eyelid retraction and familiarity with newer techniques and materials enable the oculoplastic surgeon to modify and individualize the operative repair, resulting in better surgical outcomes.

Blepharoplasty↗

PubMed2026

An Overview of Red Breast Syndrome: A Qualitative Systematic Review of the Literature and a Single-Center Case Series.

Red breast syndrome (RBS) is an uncommon inflammatory complication that may occur following implant-based breast reconstruction and can clinically mimic surgical-site infection. This qualitative systematic review, based on comprehensive PubMed and Scopus searches, summarizes the existing literature on RBS, focusing on its etiology, clinical presentation, diagnostic characteristics, and therapeutic approaches following breast reconstruction using acellular dermal matrices (ADMs). A management protocol is proposed based on available data, and a single-center case series is presented from our Hospital, including patients who developed RBS after direct-to-implant reconstruction with ADM between January 2022 and December 2024. Twenty-nine studies met the inclusion criteria, comprising case reports, case series, and retrospective or prospective cohort studies. The reported incidence of RBS ranged from 0% to 29.6%. Proposed etiologies include endotoxin contamination, residual cellular debris, delayed hypersensitivity reactions, and lymphatic or vascular impairment of mastectomy flaps. Most reports described localized erythema confined to the area of the ADM, with normal inflammatory markers and negative imaging findings, whereas antibiotic therapy frequently failed to achieve improvement. Corticosteroids represented the most consistently effective treatment, although some cases required ADM removal or replacement. In our institutional case series (n = 8), symptom onset occurred between 4 weeks and 7 months postsurgery. Inflammatory markers remained within normal limits, imaging rarely demonstrated fluid collections, and symptoms resolved within days to weeks with corticosteroid therapy or conservative management. This review consolidates current evidence, proposes a diagnostic-therapeutic algorithm and highlights the need for prospective investigations and manufacturer-level endotoxin testing to elucidate pathogenesis and optimize clinical management. Level of Evidence: 2 (Risk) For image description, please refer to the figure legend and surrounding text.

Humans↗

PubMedDate not supplied

Integrin and matrix molecule expression in cultured skin replacements.

Current tissue culture techniques enable human keratinocytes (HK) from a small section of skin to be grown into sheets of epithelium for treating extensive wounds. The additional use of dermal replacements coupled with cultured skin substitutes may improve handling properties and effect ultimate healing results. Adhesion of cultured HK grafts to wounds, and final success rates of HK grafting, are variable and frequently unsatisfactory. To evaluate adhesion molecule (integrin) expression by cultured grafts, as well as matrix molecule distribution, we performed immunohistologic analysis of integrin expression on HK cultured on plastic and a polyurethane membrane, as well as on two dermal substitutes. Multilayered HK sheet grafts were prepared by culturing cells in plastic tissue culture dishes, and HK were cultured to single-layer confluence on polyurethane membranes (Hydroderm; Wilshire Medical Inc., Dallas, Texas). Composite grafts were prepared by seeding proliferating HK on Dermagraft, composed of human neonatal fibroblasts cultured in polyglactin mesh (Advanced Tissue Sciences, La Jolla, Calif.) and on AlloDerm, an acellular human dermis (LifeCell Inc., The Woodlands, Texas). Immunohistologic staining was performed for the integrin subunits alpha 5, alpha 6, and alpha v. Staining for matrix molecules included fibronectin, laminin-1, and laminin-5. HK in cultured epithelial sheets showed integrin alpha 6 expression on basal cells, and only faint alpha 5 and alpha v staining. HK cultured to confluence on Hydroderm reacted with monoclonal antibodies specific for alpha 5, alpha 6, and alpha v. Through HK adhered well to Dermagraft, there was reduced adhesion of HK on AlloDerm that was not accelerated by addition of fibronectin. HK in composite grafts showed distinct reactivity according to the time in culture. HK on Dermagraft lost alpha 5 reactivity by day 17 and only weak alpha v reactivity was seen. Basal keratinocytes on AlloDerm, however, remained alpha 5 and alpha v positive. In both composite grafts, integrin alpha 6 expression was limited to basal keratinocytes.

Biocompatible Materials↗

PubMed1992

The role of fibroblasts in dermal vascularization and remodeling of reconstructed human skin after transplantation onto the nude mouse.

The vascularization and the dermal remodeling of two different types of human skin reconstructed "in vitro" and grafted onto the nude mouse were studied. They were composed of human keratinocytes grown either on a human acellular deepidermized dermis (DED), or on a lattice composed of human fibroblasts embedded in bovine type I collagen, a living dermal equivalent (LDE). At different stages after grafting, the transplants were harvested and processed for an immunohistological study with species-specific and non-species-specific antibodies. At one month after grafting, the two types of grafted dermis contained blood vessels whose vascular basement membranes were labeled with a mouse-specific anti-type IV collagen antibody. With an antibody specific for human type IV collagen, a constant labeling of the vascular basement membrane was only observed in the LDE containing fibroblasts. In the DED, a constant association of the mouse endothelial cells with human type IV collagen was observed at early stages after grafting. At later stages, the human type IV collagen progressively disappeared. On the other hand, the dermal-epidermal junction underneath the human epidermis contained human type IV collagen in the two types of reconstructed skin. Labeling with the species-specific antibodies directed against human or murine type I collagen showed that the ratio murine type I collagen versus human type I collagen increased with time, suggesting that the DED is progressively invaded by mouse fibroblasts that produce the mouse collagen. On the other hand, in the LDE, the preexisting bovine type I collagen became progressively undetectable while both human type I collagen and elastic fibers were deposited by numerous human fibroblasts. Mouse type I collagen was not detected. Altogether, these observations made by grafting human skin reconstructed "in vitro" onto the nude mouse should be interesting for evaluating the usefulness of grafting a dermal substrate together with the epidermal sheet in the treatment of burns.

Animals↗

PubMed2003

Advances in the management of glottic insufficiency.

PURPOSE OF REVIEW: Glottic insufficiency secondary to vocal fold scarring, atrophy, or paresis remains a clinically challenging problem for the laryngologist. Numerous methods have been described in the treatment of glottic insufficiency, belying the complexity of the problem. Type I thyroplasty and injection of fat, fascia, and gelatin powder have been the mainstay of treatment to date, but the ability to restore a normal mucosal waveform to a damaged vocal fold remains an elusive goal. RECENT FINDINGS: Advances in the material and biomedical sciences have allowed the introduction of newer substances and techniques not only to medialize the vocal fold but also to help restore its viscoelastic properties as well. These substances include expanded polytetrafluoroethylene (ePTFE), collagen, cross-linked hyaluronic acid, micronized acellular human dermis calcium hydroxyapatite, and polydimethylsiloxane. ePTFE can be introduced through a window in the thyroid ala or placed intracordally, and the others can be injected either transorally or transcutaneously, allowing in-office placement under simple topical anesthesia. SUMMARY: Although the ideal augmentation material and technique have yet to be devised, the laryngologist now has several options with which to address the problem of glottic insuffiency. Since the problem is complex and since it is possible that a customized solution may need to be devised on an individual basis, future laryngologists will need to be comfortable with the indications and applications that each material and technique will afford.

Biocompatible Materials↗

PubMed2005

Tympanic membrane perforation repair with acellular porcine submucosa.

OBJECTIVES: To evaluate the efficacy of acellular porcine small intestine submucosa in the repair of chronic tympanic membrane perforations. Although tympanoplasty with autologous temporalis fascia and cartilage is common practice in the repair of chronic tympanic membrane perforations, these materials are associated with increased operative time and have variable availability and quality in individual patients. Recently, new materials for tympanoplasty have been explored, including acellular human dermis. Small intestine submucosa (Surgisis) is an inexpensive and readily available alternative to autologous and cadaveric grafts. In this study, we examined the use of small intestine submucosa in the repair of chronic tympanic membrane perforations in a chinchilla model. STUDY DESIGN: Prospective pilot study using 10 adult chinchillas. METHODS: Chronic tympanic membrane perforations were created in 10 adult chinchillas for a total of 20 perforations. Each animal underwent observation in one ear and repair with either autologous cartilage or small intestine submucosa in the opposite ear with Type I tympanoplasty. RESULTS: A total of 20 chronic membrane perforations were created, with zero healing spontaneously after 8 weeks. In tympanoplasties performed in five chinchillas with small intestine submucosa, five of five (100%) remained healed 6 weeks postoperatively, whereas three of five (60%) remained healed with cartilage repair. Histologic analysis was performed in both successful cartilage and small intestine submucosa repairs. CONCLUSION: These results suggest that small intestine submucosa is a viable alternative to autologous and cadaveric grafts in tympanoplasty. A larger randomized study in humans is indicated to evaluate this material in clinical practice.

Animals↗

PubMed2005

Use of AlloDerm in type I tympanoplasty: a comparison with native tissue grafts.

OBJECTIVES: AlloDerm, an acellular human dermis allograft, has been shown to be an effective option as a tympanic membrane (TM) graft in animals and humans and has several potential advantages, including eliminating donor site morbidity, reducing operative time, and preserving native tissues for later use. We compared AlloDerm and native tissue grafts in type I tympanoplasty with regard to operative time, graft success rate, and audiologic outcome. STUDY DESIGN: A retrospective chart review of tympanoplasties performed at a major tertiary referral hospital over a 31 month period, starting with the first use of AlloDerm for TM grafting at this institution. METHODS: The medical charts of all patients undergoing tympanoplasty were reviewed. Only those patients undergoing type I tympanoplasty without mastoidectomy or ossicular chain reconstruction were included. These 114 patients (25 AlloDerm, 56 fascia reconstruction, and 33 fascia plus cartilage reconstruction) were compared for operative time, success rate of the graft, and change in audiologic outcome. RESULTS: There was a statistically significant reduction in operative time in the AlloDerm group when controlled for surgeon and choice of approach. All groups showed no statistically significant difference in the success rate of the graft and closure of audiologic air-bone gap, regardless of graft material used. CONCLUSIONS: AlloDerm is an effective TM graft when used in type I tympanoplasty. It is as effective as native tissues in closing the air-bone gap on audiogram as well as in graft success rate. AlloDerm may also significantly reduce operative time, depending on the surgeon's technique.

Audiometry↗

PubMed2007

Transglutaminase inhibitors induce hyperproliferation and parakeratosis in tissue-engineered skin.

BACKGROUND: The transglutaminase (TG) family consists of eight distinct isoforms. TG types 1, 3 and 5 play a major role in normal skin development, with TG2 also being elevated during dermal wounding. TG1, 3 and 5 are responsible for the cross-linking of keratin precursors and formation of the cornified envelope during keratinocyte differentiation. TG2 may play a role in keratinocyte basement membrane cross-linking. Abnormal TG expression has been demonstrated in Darier disease, Netherton syndrome, psoriasis and lamellar ichthyosis. During a recent investigation of skin contraction in tissue-engineered skin, transglutaminase inhibitors were found to produce hyperproliferation and parakeratosis. OBJECTIVES: Accordingly, this study was designed to study the effect of pan-transglutaminase inhibition on morphology of tissue-engineered skin and expression of keratinocyte differentiation and proliferation-associated antigens. METHODS: We used a tissue-engineered model of human skin, based on de-epidermized acellular human dermis, seeded with normal keratinocytes and dermal fibroblasts and cultured at an air-liquid interface. The pan-transglutaminase inhibitors putrescine, NTU283 (1-dimethyl,2-[(oxopropyl)thio]imidazolium) and NTU285 (N-benzyloxycarbonyl-l-glutaminyl-6-dimethylsulfonium-5-oxo-l-norleucine) were added to the culture medium. After 28 days, histology and immunohistochemistry for collagen IV, involucrin and cytokeratins 6, 10 and 16 were performed. RESULTS: Keratinocyte hyperproliferation and parakeratosis were seen in response to transglutaminase inhibition. Inhibition of transglutaminase also resulted in loss of basement membrane collagen IV. Involucrin and cytokeratins 6 and 16 were confined to the basal layers in control composites but expressed throughout the epidermis in response to transglutaminase inhibition. A distinct band of expression of cytokeratin 10 was seen in the upper stratum granulosum of control composites but only patchy expression was seen after transglutaminase expression. CONCLUSIONS: Pan-transglutaminase inhibition inhibits terminal differentiation of keratinocytes, leading to a hyperproliferative epidermis with parakeratosis and enhanced expression of involucrin and cytokeratins 6 and 16. Expression of the differentiation-associated cytokeratin, cytokeratin 10, is reduced. Basement membrane integrity is also lost as a result of transglutaminase inhibition.

Cell Differentiation↗

PubMed2001

Necrobiotic process causing burn wound conversion may be prevented by allogeneic keratinocytes delivered by the recombined human/pig skin.

The spontaneous necrobiotic process frequently causes conversion of DDB (deep 2nd degree wounds) into full-thickness skin loss (3rd degree wounds). We found that this process may be positively influenced by the activity of living human allogeneic keratinocytes cultured on acellular pig dermis. This RHPS, if applied 'upside-down' with the epidermal layer facing the wound, provides an opportunity for keratinocytes to influence the healing. The aim of the present study was to find conditions, in terms of timing and wound-bed preparation, for optimum healing activity of RHPS. The wound beds were prepared either with tangential excision, surface dermabrasion or deep dermabrasion. Out of 17 wounds grafted with RHPS after tangential excision, 15 (88%) healed in 4-10 days; early excised wounds (up to day 5) healed within less than 10 days after the injury. Out of 8 wounds grafted after surface dermabrasion, only 2 (25%) healed. Out of 6 wounds grafted with RHPS after deep dermabrasion, 4 (67%) healed. The optimum healing effect of RHPS and prevention of conversion was achieved in early tangentially excised wounds.

Adolescent↗

PubMed2006

Experience with acellular human dura and bovine collagen matrix for duraplasty after posterior fossa decompression for Chiari malformations.

OBJECT: Posterior fossa decompression with duraplasty is routinely used for the treatment of Chiari malformations. It has been traditionally believed that this procedure requires a watertight seal with primary closure of the dura with either pericranium or allograft. In this study, the authors evaluated two synthetic dural substitutes in this patient population for feasibility of use and identification of perioperative morbidity. METHODS: The authors evaluated 56 patients who underwent duraplasty with a synthetic collagen matrix (DuraGen) after suboccipital craniectomy and C-1 laminectomy, and 45 patients in whom the dural closure involved acellular human dermis (AlloDerm). Patients in both groups were assessed for the presence of a pseudomeningocele, wound infection, cerebrospinal fluid (CSF) leak, and the need for repeated operation either for wound revision or the placement of a ventriculoperitoneal shunt. Operative times for which DuraGen duraplasty was used were compared with those for AlloDerm closure. In the DuraGen group, complications included five pseudomeningoceles (8.9%), two wound infections (3.6%), one CSF leak (1.8%), and four repeated operations (three shunt revisions and one reexploration; 7.1%) in nine patients. In the AlloDerm group, there were five pseudomeningoceles (11.1%), one wound infection (2.2%), one CSF leak (2.2%), and two repeated operations (two shunt revisions; 4.4%) in seven patients. The operative time associated with DuraGen was significantly shorter than that of duraplasty that required closure with sutures (92 minutes compared with 128 minutes, p < 0.01). CONCLUSIONS: The synthetic dural substitutes DuraGen and AlloDerm provide a suitable alternative duraplasty with comparable complication rates. DuraGen requires a significantly shorter operative time than AlloDerm.

Adolescent↗