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Facial Plast Surg 2021; 37(05): 599-605
DOI: 10.1055/s-0041-1725163
Original Research

Use of Novel Decellularized Cadaveric Dermis (DCELL) in Single-Stage Resection and Reconstruction of Nonmelanomatous Skin Cancer of the Head and Neck

Angelos Mantelakis 
1   Department of Otolaryngology, Lewisham and Greenwich NHS Trust, London, United Kingdom
,
Argiris Kostantinos
2   Deparmnet of ENT and Facial Plastic and Reconstructive Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
,
Alwyn D'Souza
3   Department of ENT and Facial Plastic Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
,
Anil Joshi 
2   Deparmnet of ENT and Facial Plastic and Reconstructive Surgery, Lewisham and Greenwich NHS Trust, London, United Kingdom
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Abstract

Reconstructive options in nonmelanomatous skin tumors of the head and neck region are limited in the frail, elderly patient group, where split skin thickness or full thickness grafts may not be a viable option. This study examines the use decellularized cadaveric dermis (DCELL), an acellular dermis product produced in the United Kingdom for the reconstruction of these skin defects. This was a single-center, prospective study of patients undergoing single stage wide local excision of nonmelanomatous skin cancer and reconstruction with decellularized dermis. Our inclusion criteria included any patient that required a curative excision but had risk factors where conventional local flap or free tissue transfer could have a potential adverse outcome. Thirty-seven wounds were treated with DCELL in 31 patients. Mean age was 81.6 years (range 61–94 years) and at the time of operation, 25 patients (80.7%) were ASA 3 or above. The scalp was the most common anatomical area operated on (n = 28, 75.7%). The overall proportion of wounds with complete closure was 89.2% (33 out of 37 wounds), with a failure rate of 10.8% (four complete graft failures). Device-related complications included one episode of crusting over the graft which resolved with topical antibiotics, and a hypertrophic scar over the wound edges. Cosmesis was satisfactory in all cases. DCELL demonstrated a very good take rate with equally satisfactory cosmetic outcomes in patients where standard reconstructive approaches may have adverse outcomes. Further research is needed to better define its role in the management of these skin cancers.

Keywords

allograft - skin cancer - head and neck - acellular dermal matrix - decellularized dermis


Publication History

Article published online:
01 March 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Jansen LA, De Caigny P, Guay NA, Lineaweaver WC, Shokrollahi K. The evidence base for the acellular dermal matrix AlloDerm: a systematic review. Ann Plast Surg 2013; 70 (05) 587-594
    CrossrefPubMedGoogle Scholar
  • 2 Marler JJ, Upton J. Tissue engineering. In: Mathes. ed. Plastic Surgery. 2nd ed. Volume 1. Philadelphia, PA: Saunders Elsevier; 2006
    Google Scholar
  • 3 Wainwright DJ. Use of an acellular allograft dermal matrix (AlloDerm) in the management of full-thickness burns. Burns 1995; 21 (04) 243-248
    CrossrefPubMedGoogle Scholar
  • 4 Cuono C, Langdon R, McGuire J. Use of cultured epidermal autografts and dermal allografts as skin replacement after burn injury. Lancet 1986; 1 (8490): 1123-1124
    CrossrefPubMedGoogle Scholar
  • 5 Langdon RC, Cuono CB, Birchall N. et al. Reconstitution of structure and cell function in human skin grafts derived from cryopreserved allogeneic dermis and autologous cultured keratinocytes. J Invest Dermatol 1988; 91 (05) 478-485
    CrossrefPubMedGoogle Scholar
  • 6 Middelkoop E, de Vries HJ, Ruuls L, Everts V, Wildevuur CH, Westerhof W. Adherence, proliferation and collagen turnover by human fibroblasts seeded into different types of collagen sponges. Cell Tissue Res 1995; 280 (02) 447-453
    CrossrefPubMedGoogle Scholar
  • 7 Hogg P, Rooney P, Leow-Dyke S, Brown C, Ingham E, Kearney JN. Development of a terminally sterilised decellularised dermis. Cell Tissue Bank 2015; 16 (03) 351-359
    CrossrefPubMedGoogle Scholar
  • 8 Nilsen TJ, Dasgupta A, Huang YC, Wilson H, Chnari E. Do processing methods make a difference in acellular dermal matrix properties?. Aesthet Surg J 2016; 36 (Suppl. 02) S7-S22
    CrossrefPubMedGoogle Scholar
  • 9 Greaves NS, Benatar B, Baguneid M, Bayat A. Single-stage application of a novel decellularized dermis for treatment-resistant lower limb ulcers: positive outcomes assessed by SIAscopy, laser perfusion, and 3D imaging, with sequential timed histological analysis. Wound Repair Regen 2013; 21 (06) 813-822
    CrossrefPubMedGoogle Scholar
  • 10 Shridharani SM, Tufaro AP. A systematic review of acelluar dermal matrices in head and neck reconstruction. Plast Reconstr Surg 2012; 130 (Suppl. 02) 35S-43S
    CrossrefPubMedGoogle Scholar
  • 11 Macadam SA, Lennox PA. Acellular dermal matrices: use in reconstructive and aesthetic breast surgery. Can J Plast Surg 2012; 20 (02) 75-89
    CrossrefPubMedGoogle Scholar
  • 12 Fosnot J, Kovach III SJ, Serletti JM. Acellular dermal matrix: general principles for the plastic surgeon. Aesthet Surg J 2011; 31 (Suppl. 07) 5S-12S
    CrossrefPubMedGoogle Scholar
  • 13 Jackson IT, Yavuzer R, Silverstein P. AlloDerm for dorsal nasal irregularities. Plast Reconstr Surg 2001; 107 (02) 559-560
    CrossrefPubMedGoogle Scholar
  • 14 Gryskiewicz JM, Rohrich RJ, Reagan BJ. The use of alloderm for the correction of nasal contour deformities. Plast Reconstr Surg 2001; 107 (02) 561-570 , discussion 571
    CrossrefPubMedGoogle Scholar
  • 15 Gryskiewicz JM. Waste not, want not: the use of AlloDerm in secondary rhinoplasty. Plast Reconstr Surg 2005; 116 (07) 1999-2004
    CrossrefPubMedGoogle Scholar
  • 16 Kridel RW, Foda H, Lunde KC. Septal perforation repair with acellular human dermal allograft. Arch Otolaryngol Head Neck Surg 1998; 124 (01) 73-78
    CrossrefPubMedGoogle Scholar
  • 17 Wester JL, Pittman AL, Lindau RH, Wax MK. AlloDerm with split-thickness skin graft for coverage of the forearm free flap donor site. Otolaryngol Head Neck Surg 2014; 150 (01) 47-52
    CrossrefPubMedGoogle Scholar
  • 18 Levin F, Turbin RE, Langer PD. Acellular human dermal matrix as a skin substitute for reconstruction of large periocular cutaneous defects. Ophthal Plast Reconstr Surg 2011; 27 (01) 44-47
    CrossrefPubMedGoogle Scholar
  • 19 Bee YS, Alonzo B, Ng JD. Review of AlloDerm acellular human dermis regenerative tissue matrix in multiple types of oculofacial plastic and reconstructive surgery. Ophthal Plast Reconstr Surg 2015; 31 (05) 348-351
    CrossrefPubMedGoogle Scholar
  • 20 Hayek B, Hatef E, Nguyen M, Ho V, Hsu A, Esmaeli B. Acellular dermal graft (AlloDerm) for upper eyelid reconstruction after cancer removal. Ophthal Plast Reconstr Surg 2009; 25 (06) 426-429
    CrossrefPubMedGoogle Scholar
  • 21 Shorr N, Perry JD, Goldberg RA, Hoenig J, Shorr J. The safety and applications of acellular human dermal allograft in ophthalmic plastic and reconstructive surgery: a preliminary report. Ophthal Plast Reconstr Surg 2000; 16 (03) 223-230
    CrossrefPubMedGoogle Scholar
  • 22 Li TG, Shorr N, Goldberg RA. Comparison of the efficacy of hard palate grafts with acellular human dermis grafts in lower eyelid surgery. Plast Reconstr Surg 2005; 116 (03) 873-878 , discussion 879–880
    CrossrefPubMedGoogle Scholar
  • 23 Fisher E, Frodel JL. Facial suspension with acellular human dermal allograft. Arch Facial Plast Surg 1999; 1 (03) 195-199
    CrossrefPubMedGoogle Scholar
  • 24 Vural E, McLaughlin N, Hogue WR, Suva LJ. Comparison of biomechanical properties of alloderm and enduragen as static facial sling biomaterials. Laryngoscope 2006; 116 (03) 394-396
    CrossrefPubMedGoogle Scholar
  • 25 Rhee PH, Friedman CD, Ridge JA, Kusiak J. The use of processed allograft dermal matrix for intraoral resurfacing: an alternative to split-thickness skin grafts. Arch Otolaryngol Head Neck Surg 1998; 124 (11) 1201-1204
    CrossrefPubMedGoogle Scholar
  • 26 Girod DA, Sykes K, Jorgensen J, Tawfik O, Tsue T. Acellular dermis compared to skin grafts in oral cavity reconstruction. Laryngoscope 2009; 119 (11) 2141-2149
    CrossrefPubMedGoogle Scholar
  • 27 Steele MH, Seagle MB. Palatal fistula repair using acellular dermal matrix: the University of Florida experience. Ann Plast Surg 2006; 56 (01) 50-53 , discussion 53
    CrossrefPubMedGoogle Scholar
  • 28 Sclafani AP, Romo III T, Jacono AA, McCormick SA, Cocker R, Parker A. Evaluation of acellular dermal graft (AlloDerm) sheet for soft tissue augmentation: a 1-year follow-up of clinical observations and histological findings. Arch Facial Plast Surg 2001; 3 (02) 101-103
    CrossrefPubMedGoogle Scholar
  • 29 Govindaraj S, Cohen M, Genden EM, Costantino PD, Urken ML. The use of acellular dermis in the prevention of Frey's syndrome. Laryngoscope 2001; 111 (11 Pt 1): (01) 1993-1998
    CrossrefPubMedGoogle Scholar
  • 30 Pipkorn P, Sinha P, Zenga J, Graboyes E, Haughey BH. Acellular dermal graft pharyngeal repair augmentation after laryngectomy. Am J Otolaryngol 2017; 38 (03) 329-332
    CrossrefPubMedGoogle Scholar
  • 31 Benecke Jr JE. Tympanic membrane grafting with alloderm. Laryngoscope 2001; 111 (09) 1525-1527
    CrossrefPubMedGoogle Scholar
  • 32 Warren WL, Medary MB, Dureza CD. et al. Dural repair using acellular human dermis: experience with 200 cases: technique assessment. Neurosurgery 2000; 46 (06) 1391-1396
    CrossrefPubMedGoogle Scholar
  • 33 Hilton CMH, Hölmich LR. Full- or split-thickness skin grafting in scalp surgery? Retrospective case series. World J Plast Surg 2019; 8 (03) 331-337
    PubMedGoogle Scholar
  • 34 Kim S, Chung SW, Cha IH. Full thickness skin grafts from the groin: donor site morbidity and graft survival rate from 50 cases. J Korean Assoc Oral Maxillofac Surg 2013; 39 (01) 21-26
    CrossrefPubMedGoogle Scholar
  • 35 Keh SM, Giblett N, Ahsan SF. Through-and-through mattress suturing versus tie-over dressing in full-thickness skin graft reconstruction. Turk Arch Otorhinolaryngol 2017; 55 (03) 119-124
    CrossrefPubMedGoogle Scholar