Dermal augmentation alloderm graft-

Background Physicians tend to overcorrect when applying the acellular dermal matrix for reconstructive option because of volume decrement problem after absorption comparing with initial volume. However, there are no studies on the exact volume decrement and absorption rate with commercial products in South Korea. To figure out absorption rate of acellular dermal matrix product in South Korea Megaderm , authors designed this experiment. Methods Nine mice were used and randomly divided into three groups by the time with sacrificing. The implant Megaderm was tailored to fit a cuboid form 1.

Dermal augmentation alloderm graft

Dermal augmentation alloderm graft

Dermal augmentation alloderm graft

Dermal augmentation alloderm graft 0. However, in general clinical practice, acellular dermal matrix of the thickness above 1 mm is usually used. The study sample consisted of 25 patients 24 females and gtaft male. A skin incision was made at anterior chest with blade 15 scalpel with exposing the pectoralis major muscle. Lip augmentation with AlloDerm acellu-lar allogenic dermal graft and fat autograft: a comparison with autolo-gous fat injection alone.

Water loving evergreen trees. Materials and Methods

Israeli on new advancement in Bottom tab index Once the dermal graft is placed in the defective area, it is sutured sometimes grzft to the surrounding healthy skin where it starts to integrate itself Dermal augmentation alloderm graft the new location by building new vessels for blood supply. An injectable form of AlloDerm is under clinical investigation. Risks and complications specifically reported with Dermal Fat Graft Degmal Penile Augmentation procedures include, but are not limited to, the following: Absorption of implanted Dermal Fat Graft DFG with consequent loss of initially achieved dimensions Shrinkage of dermal fat graft DFG with subsequent Dermal augmentation alloderm graft deformity Shrinkage of dermal fat graft DFG with subsequent penile shortening Fat tissue fibrosis reported 8 weeks after surgery Infection Detachment of the graft failure to take Necrosis death of the dermal fat graft DFG with associated severe internal adhesions causing severe penile deformity Post-operative complications due to prolonged surgery time of hours Augmentatiob penile edema with skin induration Penile skin scarring and loss Penile asymmetry due to fat tissue fibrosis Wound healing problems of donor site buttocks Infection of donor Dermal augmentation alloderm graft buttocks Prolonged pain and disability due to skin defect at the donor site Cosmetically unpleasant scarring at donor site. This approach significantly improves the likelihood of minimizing patient complications ie 3. I had no infection. I should have asked why. A penile skin reconstruction was performed after removal of the severely infected dermal fat graft and wound clean up. Other materials lipocytic dermal augmentation products 3 and Isolagen 4 Christian teen party dresses been introduced that attempt to induce or replicate a dermal reparative process, thereby producing autologous tissue for augmentation. Our investigation of AlloDerm has revealed it to have superior clinical persistence, based on volumetric analysis, having 6 times the percentage volume persistence Dermap implanted material vs Zyplast at 3 months. Institutional sign in: OpenAthens Shibboleth. Sawhney et al [27] documented the changes in size and consistency of a dermal fat graft vraft penile girth enhancement. And if so when should I expect xugmentation to be back and to be able to get the surgery performed? The pec muscle augmentaion cover the entire implant.

Richard Jones, Barry M.

  • Correspondence Address: Dr.
  • Before being packaged for use, the Alloderm undergoes a multi-step process that removes all the cells that can lead to tissue rejection: even though it comes from another person, your body does not reject Alloderm because the immune cells are removed.
  • Mean percentage volume persistence of acellular dermal graft AlloDerm vs type I bovine collagen cross-linked with glutaraldehyde Zyplast.
  • BioHorizons Chile, S.
  • The following material is solely for informational purposes.
  • There are many challenges faced by plastic surgeons as they strive to achieve optimal results in implant-based breast reconstruction.

Wyatt C. To, Brook M. Seeley, Stanley A. Castor, Frank A. Although many methods for cosmetic lip augmentation are available, none represents an ideal solution. A quantitative analysis of surgical lip augmentation was undertaken comparing AlloDerm Lifecell Corp. Horizontal stab incisions were made at the vermilion border in the lateral commissure of the lip. AlloDerm grafts were affixed to the end of the awl, pulled through the tunnel, and held in place with interrupted 4—0 chromic sutures.

Volume measurements were taken at 1 month, 3 months, and 1 year after operation. Mean vermilion show was substantially increased at 1 month after surgery in both groups. At 12 months, mean vermilion show had decreased 0. AlloDerm used with injected autologous fat appeared to result in a long-lasting increase in vermilion show and lateral lip projection.

Future studies with quantitative analysis of surgical outcomes can be used to compare various allograft implantation techniques and identify the optimum technique for maximum volume maintenance. The increasing popularity of thick, full lips in Western popular culture has inspired a renewed interest in cosmetic lip augmentation.

The use of mucosal flaps, exogenous implants, autologous dermis, and autologous fat has been described for lip augmentation. Although these methods all have their own advantages and disadvantages, none represents an ideal technique that can provide a safe, reliable, and long-lasting result.

The use of AlloDerm Lifecell Corp. AlloDerm is an allogenic, acellular dermal graft processed from tissue-banked human skin. Because of its acellular nature, this material is nonimmunogenic.

AlloDerm has more recently been used for the treatment of facial defects, depressed scars, septal perforations, and nasolabial fold and lip augmentation. We chose to use AlloDerm instead of autogenous dermal grafts because of the lack of donor site morbidity, reduced procedure time, and absence of risk for postoperative epidermal inclusion cysts.

In this study, we provide a quantitative analysis comparing surgical results in lips treated with AlloDerm allogenic dermal graft and fat autograft versus those treated with fat autograft alone. Six adult female patients between the ages of 25 and 58 years were included in the study. Three underwent autol-ogous fat injection of the lips by use of the Coleman technique 6 to a total of 4 lips. Three patients received an AlloDerm acellular dermal graft in addition to autolo-gous fat injection to a total of 5 lips.

One patient in the AlloDerm group had undergone traumatic cleft lip repair. The combination was typically performed with the patient under local and regional anesthesia on an outpatient basis. Horizontal stab incisions were made with a number 11 blade at the vermilion border in the lateral commissure of the lip through the moist mucosa Figure 1. A plane superficial to the orbicularis oris muscle was identified by use of blunt scissors and developed for approximately 1 to 1.

Horizontal stab incisions made at the vermilion border in the lateral commissure of the lip through the moist mucosa.

The AlloDerm graft was prepared by rehydration in sterile normal saline solution for 2 sequential 5-minute periods, with each period performed in a separate sterile container. The soft, pliable AlloDerm was trimmed to the appropriate dimensions with scissors and fashioned into a cigarette shape by rolling it upon itself Figure 3. Interrupted chromic sutures secured the roll. Sutures were placed at each end of the rolled graft and at the regions of predetermined high points of the vermilion cupid's bow for the upper lip and in the midline for the lower lip.

The diameter of this cigarette-shaped graft ranged from 5 to 8 mm, depending on the desired degree of augmentation. The graft was then affixed to the end of the canthal awl and pulled through the previously created submucosal tunnel Figure 4. After careful positioning of the graft, it was held in place with 2 interrupted chromic sutures placed in the submucosal plane at the commissures.

AlloDerm trimmed to the appropriate dimensions with scissors and fashioned into a cigarette shape by rolling it upon itself.

AlloDerm affixed to the end of the canthal awl and pulled through the previously created submucosal tunnel. Fat for injection was harvested in the standard fashion. The fat was injected on withdrawal of the cannula and only within the orbicularis oris musculature. Care was taken to avoid entering the vermilion submucosal region of the previously placed AlloDerm graft. Several dozen passes were made per lip injected, allowing fine sculpting of the lip contour and shape.

Finally, the stab incisions were closed with interrupted chromic sutures. Standard preoperative and 1-, 3- and month postoperative photographs were compared by use of digital imaging software Adobe Photoshop 4. On the lateral-view photographs, a vertical line connecting the subnasale to the soft-tissue pogo-nion served as a reference plane and control length Figure 5. Vermilion show was measured as the vertical distance of the exposed vermilion from the white roll to the wet line in each lip.

Taking the 1-month postoperative vermilion show as the baseline maximum value, estimated volume maintenance was determined. Estimated volume maintenance was defined as the retention of the 1-month postoperative increase in vermilion show, determined at the 3- and month postoperative periods. Lateral illustration demonstrates the vertical line connecting the subnasale SN to the soft-tissue pogonion PG , which serves as a reference plane and control length.

The measurements for upper lip projection A-B and lower lip projection are shown. The horizontal lines mark the upper and lower extent of vermilion show. A substantial increase in mean vermilion show was seen in both groups of patients at 1 month after operation Figure 6. In comparison with the 1-month postoperative result, mean vermilion show was unchanged at 3 months after operation and decreased 0.

In lips treated with fat only, mean vermilion show decreased 0. Mean projection from the subnasale-pogonion plane for lips treated with AlloDerm and fat increased from 1. This increased projection remained basically unchanged at 3 and 12 months after surgery Figure 8. Patient examples are shown in Figures 9 and A, C, Preoperative views of a year-old woman who desired increased lip fullness and projection.

B, D, Postoperative views 1 year after lip augmentation. A, Preoperative view of a year-old woman who desired increased fullness of her upper lip. B, Postoperative view 1 year after lip augmentation. The numerous methods of lip augmentation available suggest the lack of an ideal treatment.

Excellent clinical results have been published on lip augmentation with AlloDerm. Our method of evaluating lip projection was similar to that described by Wang et al, 7 in which soft tissue surface landmarks were used to measure changes in projection. It is unlikely that the location of the subnasale and pogonion would have changed significantly during 1 year follow-up, allowing for quantitative comparison of lip projection with these reference points.

Volume maintenance is a difficult measure to quantify by use of existing methods, because by definition volume is a 3-dimensional quantity.

Our approximation of volume maintenance was derived from 2-dimensional measurements of maximum vermilion show. The baseline for the postoperative vermilion show was taken 1 month after surgery to allow for immediate postoperative edema to subside.

The lasting increase in lip projection seen after 3 months and 1 year is consistent with this result. Other reports of autologous and allogenic dermis used in lip augmentation seem to corroborate our result.

Our surgical technique for subvermilion implantation of AlloDerm is evolving. We currently use four 3- to 5-mm-wide strips of AlloDerm that are separately implanted within the vermilion to allow for potentially greater allograft surface exposure to the local vascularized bed. The most obvious limitation of this study is the small number of patients studied. However, this method of evaluating lip volume and projection may be helpful in the study of this or other techniques of lip augmentation.

By emphasizing quantitative analysis of surgical outcomes, we may eventually develop a more scientific basis for the cosmetic procedures that we perform for our patients.

Our results in a very small group of patients seem to indicate that AlloDerm acellular dermal graft used in conjunction with fat autograft for lip augmentation allows for lasting improvements in lip volume and projection. Future studies are indicated to compare various allograft implantation techniques to identify the optimum technique for maximum volume maintenance.

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Volume Article Contents. To, MD. Oxford Academic. Google Scholar. Brook M. Seeley, MD. Stanley A. Castor, MD. Castor is in private practice in Lakeland, FL. Frank A. Papay, MD. Cite Citation. Permissions Icon Permissions.

The most significant drawback of bovine collagen is its rapid month resorption by the body and loss of clinical effect. Cost-effectiveness of one-stage versus two-stage breast reconstruction in the United Kingdom. Patients and methods. Again, the apparent surface area and lateral projection caused by the implant was measured, the implant shape approximated to a cylinder, and the volume of the implant calculated. In addition, as the inferior pole is covered solely by a thin skin flap, there is a risk of implant migration, poor visibility, palpability, and excessive ptosis. These properties make alloderm an excellent support material for breast reconstruction.

Dermal augmentation alloderm graft

Dermal augmentation alloderm graft

Dermal augmentation alloderm graft

Dermal augmentation alloderm graft

Dermal augmentation alloderm graft. AlloDerm Regenerative Tissue Matrix

The same principle is also used in penile dermal grafting where a free graft is harvested from the buttock area and placed into the penis, underneath the shaft skin and over the erectile body. Sutured in place or fixed using other techniques the dermal graft eventually starts to integrate and grow inside the underlying shaft tissue as well as partially or completely into the overlying skin. Ideally, the dermal graft should act as an inert material, which would not adhere to the underlying or overlying structures allowing a free movement on the skin on the shaft of the penis.

Furthermore, any type of graft should ideally be reaching further into the pubic area, where a major part of the penis is sitting and moving out upon erection, in order to prevent a gapping between the grafted area and the base of the penis upon erection. This characteristic can only be achieved by an inert material, which does not adhere to the skin or shaft tissue. While the success rate of Dermal Grafts is described as superior when compared to AlloDerm and fat injections, the complication rates are also widely understated.

It is true, however, that initial gains with Dermal Fat Grafts seem to be greater when compared to AlloDerm, and more homogenous when comparing to fat injection. The simple fact is that, except for biologically inert materials, all grafts consisting of natural tissue used for penile augmentation, or closure of any kind of tissue defect, will undergo physiological changes, especially if inserted into areas of the body where fat grafting is not recommended.

A review by Sexual Medicine:. A dermal fat graft is a dermis-free graft that consists of all layers of skin and the underlying subcutaneous tissue after removal of the epidermis [27].

The first known human adipose tissue transplantation was attempted in by Neuber [28]. Since then, accumulated data have shown that the acceptance of and survival of the grafted adipocytes depends on a quick, atraumatic, sterile transfer of the graft and its early revascularization. Final results depend mainly on the amount of fat which is reabsorbed and replaced by fibrous tissue and on the remaining bulk of dermal tissue.

Sawhney et al [27] documented the changes in size and consistency of a dermal fat graft for penile girth enhancement. This technique has significant disadvantages such as prolonged operative time 7 h and a high incidence of postoperative complications: persistent postoperative penile edema and induration, venous congestion, and possible skin injury [9]. Donor-site scarring and deformity of the buttock crease or the suprapubic region are often cosmetically unpleasant, and curvature and shortening of the penis, as well as penile asymmetry due to fibrosis may occur [9].

Nevertheless, after reviewing all published reports on this technique, we found that it gave inconsistent results and that the complication rates were high, and for these reasons we conclude that dermal fat grafting is not an acceptable procedure for penile girth enhancement. Penile elongation and girth enhancement. AUA Update Series ;— Behaviour of dermal fat transplants. Br J Plast Surg ;— Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery.

Plast Reconstr Surg ; — Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: considerations regarding patient selection, outcome evaluation and techniques applied. Eur Urol ; —8. As with all types of penile enlargement surgical procedures, Dermal Graft or Dermal Fat Grafting DFGs Penile Augmentation procedures can also be associated with general complications such as swelling, bleeding, pain, hematoma, and infection.

Risks and complications specifically reported with Dermal Fat Graft DFG Penile Augmentation procedures include, but are not limited to, the following:. The extent of damages caused by Dermal Fat Graft DFG Penile enhancement procedures is best illustrated by the following case, which was presented to our facility for revisional surgery:. Because of variations in the thickness of AlloDerm sheets, the volume of implanted AlloDerm varied between 0.

No patients experienced any signs or symptoms of implant infection, rejection, allergic reaction, or extrusion. AlloDerm persistence at all points was statistically greater than that for Zyplast. The mean percentage volume persistence of AlloDerm at 1 and 3 months was Fifteen patients were enrolled 5 men and 10 women; average age, 46 years; age range, years.

All patients attended their 4-week follow-up visits and biopsy appointments, but 4 were unable to attend the 1-week follow-up visit.

No infections developed around the injection sites and no signs of allergic reaction to any implant were noted. Most patients experienced only minimal discomfort for 1 to 3 hours after injection. In light of this and the histological results vide infra , all micronized AlloDerm implants at a given location intradermal or subdermal were considered together for further analysis. The mean percentage volume persistence of all intradermally injected AlloDerm at implantation, at 1 week, and at 4 weeks was The mean percentage volume persistence of intradermally injected Zyplast initially, at 1 week, and at 4 weeks was The mean percentage volume persistence of subdermally injected AlloDerm at implantation, at 1 week, and at 4 weeks was When intradermally injected AlloDerm was compared with subdermally injected AlloDerm, there was a statistically significant difference in the mean percentage volume persistence noted at implantation Micronized AlloDerm was present in all 1-month biopsy specimens, and AlloDerm was seen in all 3-month biopsy specimens.

Zyplast was observed in all 1- and 3-month specimens. Intraimplant fibroblast activity was noted in all of the specimens with AlloDerm and micronized AlloDerm but not in any of the specimens with Zyplast Figure 4 and Figure 5. Minimal peri-implant inflammation was observed around all specimens with AlloDerm, micronized AlloDerm, and Zyplast. No giant cell reaction was noted in any treatment group. We have investigated the use of AlloDerm for surgical soft tissue augmentation.

In addition, we examined a new material, micronized AlloDerm an injectable acellular dermal graft , for the same purpose. Unlike bovine collagen, which is treated to remove the telopeptide units reducing antigenicity but causing loss of collagen fiber alignment, AlloDerm contains only human proteins and replaces dermal deficits with identical tissue, ie, an acellular matrix of dermal proteins. AlloDerm has been used to obliterate soft tissue deficits after tumor excision and for dorsal nasal augmentation, lip augmentation, and effacement of nasolabial folds and depressed scars.

The ultrastructure of the dermal matrix is maintained after AlloDerm sheets are homogenized to create the micronized product. Bovine collagen is the simplest and most commonly used biological filler material; because of this, it remains the criterion standard for injectable biological fillers.

It is easily placed and generally well tolerated. The most significant drawback of bovine collagen is its rapid month resorption by the body and loss of clinical effect.

Bovine collagen enjoys its status as the most commonly used injectable filler because of its availability and ease in use. Bovine collagen acts as a foreign body and undergoes a slow resorption during a 3-month period, modulated by the inflammatory cells at the implant periphery. Our investigation of AlloDerm has revealed it to have superior clinical persistence, based on volumetric analysis, having 6 times the percentage volume persistence of implanted material vs Zyplast at 3 months.

Histologically, there was a significant difference in the degree of intraimplant fibroblasts, with all AlloDerm implants showing intraimplant proliferation of fibroblasts and Zyplast implants revealing no proliferation.

There was no significant difference in the mild degree of peri-implant inflammation noted in both groups. It is clear from this small sample that AlloDerm supports tissue ingrowth and, therefore, volume persistence should continue, decreasing the need for subsequent treatments, which is often the case with injectable bovine collagen. Some resorption of the material may occur, or this volume loss may be due to consolidation of scar tissue. Based on these findings, some degree of clinical overcorrection appears to be necessary; the precise degree of overcorrection will depend on factors associated with a particular defect, but overcorrection by a factor of at least 2 may be necessary.

Areas where lost tissue volume is being replaced with AlloDerm may be more forgiving that those sites undergoing augmentation as in our experimental model.

In addition, biological implants placed near areas of active muscular contraction and mechanical skin stress may be more prone to resorption of material. Our investigation of micronized AlloDerm has revealed it to have superior clinical persistence, based on volumetric analysis, with twice the percentage volume persistence of intradermally injected material vs Zyplast at 1 month.

Histologically, there was a significant difference in the degree of intraimplant fibroblast ingrowth. All AlloDerm implants showed intraimplant proliferation of fibroblasts, and Zyplast implants revealed no proliferation. It is clear from this small sample that micronized AlloDerm supports tissue ingrowth; this should continue to stabilize the implant, to improve persistence, and ultimately to decrease the need for subsequent treatments.

Obviously, the long-term benefits and ultimate fate of micronized AlloDerm are unknown. Possibilities include resorption of the micronized AlloDerm with or without replacement by reactive fibroplasia or incorporation of the material with cellular ingrowth.

The fibroblasts observed in the interior of the micronized AlloDerm implants could mediate any of these possible outcomes. The clinical effect of subdermal injection of micronized AlloDerm was quickly lost and clearly inferior to intradermally injected micronized AlloDerm. Although injections were initially localized to a discrete area, the loose connective tissue in the subdermal plane in the postauricular area may have allowed rapid dispersion of the micronized AlloDerm. This is in distinct contrast to AlloDerm sheets, which do not disperse and have a broad, continuous surface that anchors quickly to surrounding tissues.

The long-term persistence and histological study of AlloDerm and Zyplast at 12 months after implantation is pending. We compared the macroscopic and microscopic behavior of subdermally implanted AlloDerm sheets with that of intradermally injected Zyplast. Clinically, AlloDerm sheet volume persisted to a significantly greater degree than bovine collagen volume. Histologically, AlloDerm is well tolerated, supports host tissue ingrowth with fibroblast ingrowth and collagen deposition, and appears to provide improved and longer-lasting correction of soft tissue deficits at 1- and 3-month follow-up visits compared with Zyplast.

In addition, we compared the macroscopic and microscopic behavior of intradermally and subdermally injected micronized AlloDerm with that of intradermally and subdermally injected Zyplast. Clinically, the volume of intradermally injected micronized AlloDerm persisted to a significantly greater degree than the volume of bovine collagen. Histologically, micronized AlloDerm is well tolerated and supports host tissue ingrowth with fibroblast ingrowth and collagen deposition.

Micronized AlloDerm holds great promise for use in correction of dermal tissue deficits and may hold significant advantages over injectable bovine collagen and even AlloDerm sheets.

Reprints: Anthony P. All Rights Reserved. Figure 1. View Large Download. Injectable collagen: a six-year clinical investigation.

Aesthetic Plast Surg. Aesthetic Surg J. Autologous collagen? J Dermatol Surg Oncol. Dermatol Surg. Clinical evaluation of an acellular allograft dermal matrix in full-thickness burns. J Burn Care Rehabil. The use of processed allograft dermal matrix for intraoral resurfacing: an alternative to split-thickness skin grafts. Arch Otolaryngol Head Neck Surg.

Aesthetic Surg Q. Transplanted acellular allograft dermal matrix. Augmentation of facial soft-tissue defects with AlloDerm dermal graft. Ann Plast Surg. Am J Cosmetic Surg. J Oral Maxillofac Surg. See More About Dermatology. Save Preferences. Privacy Policy Terms of Use. This Issue. Citations 0. View Metrics. Original Article. Anthony P. Patients and methods. Preparation of alloderm sheets and micronized alloderm. AlloDerm Sheets. Micronized AlloDerm. Histopathologic features.

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Aesthetic Plastic Surgery. Many surgical options exist for lip augmentation, none of which consistently provide safe, lasting, and predictable volume gains.

We describe and evaluate the use of AlloDerm acellular allogenic dermal graft in combination with fat autograft and compare the postoperative results with those of autologous fat injection alone. Analysis of the preoperative and 1- and 3-month postoperative photographs was done using digital imaging software. Outcome measures included vermilion show and horizontal lip projection from the soft tissue pogonion—subnasale plane.

No complications occurred in either group. We conclude that AlloDerm in conjunction with autologous fat injection constitutes a safe, reliable, and lasting method of lip augmentation providing increased vermilion show compared to that with autologous fat injection alone. Unable to display preview. Download preview PDF. Skip to main content. Advertisement Hide.

Authors Authors and affiliations Stanley A. Castor Wyatt C. To Frank A. Key words: Lip augmentation—AlloDerm—Reconstructive surgical procedures—Transplantation, autologous—Follow-up studies. This is a preview of subscription content, log in to check access. Stanley A. Castor 1 Wyatt C. To 1 Frank A. Papay 1 1. Personalised recommendations. Cite article How to cite?

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Dermal augmentation alloderm graft

Dermal augmentation alloderm graft