Overview

The World Health Organization reports that around 180,000 people die from burns every year. As a leading cause of morbidity, non-fatal burns lead to prolonged hospitalization. Because of the disability and disfigurement caused by burns, burned persons are often stigmatized and rejected. Disability and disfigurement caused by burn damage may also lead to depression. Also, some burn victims have nightmares or post-traumatic stress disorder or PTSD.

Specifically, burned persons suffer contractures, a form of disability. Contractures are the permanent tightening of soft tissues such as muscles, ligaments, and tendons. The skin may get contractures as well. Contractures may cause pain or loss of motion in a joint. In this case, a second or third-degree burn may cause the skin to pull together, restricting its movement. Another effect of burns is disfigurement in the form of scars. 

Similar to contractures, scars may not only limit movement but also limit interaction with other persons. In a time where likes define your worth, finding your place in this world as a disfigured person may be difficult. Not only psychologically, but scars may also cause problems on the physiological front. Remember that scars may limit movement. When the skin is all bunched up, stretching it to do something may not be possible.

For contractures and scars brought about by burns, an acellular human dermal matrix graft has been developed. Known as AlloDerm, this graft or implant is derived from cadavers. Despite being from cadavers, all donor cells and allergenic substances are removed. AlloDerm has growth factor receptors and vascular tissue, which aids in the regenerative process. 

This implant is also used as a treatment for second-degree or third-degree burns. On the one hand, a second-degree burn, also known as partial-thickness burn, affect the topmost layer of the skin or the epidermis down to the dermis. The dermis contains sensory receptors. For this reason, a second-degree burn is the most painful. A third-degree burn, on the other hand, is also known as a full-thickness burn. This type of burn destroys two full layers of the skin. This burn is not painful because it completely damages nerve endings. Though the AlloDerm will not repair nerve endings, this implant or graft will serve as a sleeve that can help a repaired nerve regenerate effectively. 

AlloDerm is also being used in dentistry and plastic surgery. A graft from the palate of a donor is attached to the gums of a person. This is essential for gums that are exposing teeth. Because of its poor attachment, an exposed tooth is prone to movement. The constant movement brought about by chewing may cause the tooth to fall off eventually. With AlloDerm, the grafted palate will be attached to the gums. The process is effective as such graft has successfully meshed itself with the gums, providing better structural support for the tooth.

Further, AlloDerm is a safe and effective add-on graft for repairing cleft palates. According to the Centers for Disease Control and Prevention or CDC, about 1 in every 1,700 babies is born with cleft palate in the United States. Mayo Clinic has cited surgery as the recommended course of action within the first 18 months of life. Aside from improving the facial features of the child, surgical repair may also improve breathing. In addition, repair of cleft palate may aid in hearing and language development of the child.   

This implant can also prevent complications brought about by surgery. Also known as Frey Syndrome, the nerve responsible for making saliva may be damaged in the removal of the parotid gland. After removing this gland, the use of AlloDerm may lessen the incidence of Frey Syndrome. 

The AlloDerm may also be used in breast reconstruction in case of a mastectomy. Attaching the graft may allow for the creation of a full-sized breast when this is performed at the same time with the mastectomy. 

Side Effects

Almost all grafts that are implanted on the body have a risk of rejection. However, all the cells that can lead to tissue rejection have been removed through multiple processes with the AlloDerm. Some side effects of the AlloDerm are bruising, contusions, swelling, and inflammation. Other side effects are infection and abscess development.

Dosage and Administration

There are no studies yet on limiting the use of AlloDerm. But because the live body does not reject the implant, it may be used large-scale. To attach AlloDerm requires several steps. The graft is hydrated as per the manufacturer’s recommendations. In most cases, the graft meshes with STSG or a split-thickness skin graft. This maximizes revascularization and healing. However, the AlloDerm may be applied as a solid sheet. The patient is given local or general anesthesia. The area will be cleaned thoroughly. The unhealthy or dead tissue will be removed. The surgeon will then place the skin graft on the wound site. The surgeon will apply medication and do procedures that will help in binding the graft with the natural skin. Gauze will be used to protect the site. As the graft adheres to the skin, the surgeon may use more bandages to secure the skin graft. 

Drug Interaction

After applying the AlloDerm, take note of the antibiotic that the doctor has applied. Make sure not to use any drugs that may interact with its efficacy. In burn patients, some surgeons apply ceftazidime, ampicillin, and amphotericin after attaching the graft. Ceftazidime is an antibiotic. Some medications like aspirin, epinephrine, Lasix, tobramycin, and Vitamin K may interact with ceftazidime. 

Also, some drugs or vaccines which may have severe interactions with ampicillin are Vivotif, which is a live typhoid vaccine, warfarin, which is an anticoagulant, and methotrexate which is an antimetabolite used to treat rheumatoid arthritis. For amphotericin, drugs that may interact include anti-cancer drugs such as mechlorethamine, azole antifungals such as ketoconazole, cidofovir, and medications that affect the kidneys such as pentamidine. 

Warnings and precautions

After the procedure, a diet rich in calories and protein may be prescribed to aid the healing process. Protein will help repair the adherence of the graft with the natural skin. Foods rich in protein are lean meat, poultry, fish, eggs, seeds, soy products like tofu, and beans and legumes. Some foods rich in calories are avocado, baked beans, butter, dark chocolate, eggs, and cheese. Taking-in vitamin C can also aid in healing. Vitamin C rich foods are broccoli, cantaloupe, cauliflower, strawberries, and tomatoes. It is important to ask your doctor which foods are allowed in your diet. You may have other illnesses that do not allow the intake of some specific foods.

Also, pain medication will be prescribed. It is best to take it as instructed. Further, patients are advised to protect the skin graft site by keeping it dry at all times. 

Most importantly, avoiding strenuous activities is also required to prevent detachment. It is best to rest at home as per doctor’s instructions. There may be slight bleeding and swelling. This may get uncomfortable. When the bleeding becomes heavy and the swelling very large, see your doctor immediately. Also, see your doctor immediately when you see pus oozing out of the bandage. This may be a sign of infection.

Contraindications

No studies are specifying contraindicated medications to AlloDerm. What is contraindicated, however, is to do strenuous activities after attachment of the graft.   

Clinical pharmacology

With its regenerative properties because of the presence of growth factors in the ADM or acellular dermal matrix, AlloDerm is being used in burn reconstruction, breast reconstruction, and augmentation. This graft is also being used to reconstruct the abdominal wall and urethral parts too. Moreso, the AlloDerm is popular in gingival reconstruction. This implant is also used to repair cleft palates. Another important and retained tissue in the graft is vascular tissue.

Graft guide

AlloDerm Regenerative Tissue Matrix (RTM) is one of the leading ADM for soft tissue applications. AlloDerm maintains tissue integrity and promotes tissue regeneration by revascularizing and repopulating fibroblasts for a strong repair. The applications of this graft include root coverage, gingival augmentation, and soft tissue augmentation around implants. According to the AlloDerm’s catalog, this implant may also be used for soft tissue ridge augmentation, graft protection, and containment, and as a flap, extender to achieve primary closure.

Among other accidents, burns have devastating effects. Those who have been debilitated or disfigured due to burns may become disheartened and even disillusioned. Like what Dave Wilson said: “Sometimes life gives you a second chance, or even two! Not always, but sometimes. It’s what you do with those second chances that count.” With research and development redefining medicine, some inventions like the AlloDerm is a revolution in itself – a revolution meant to give you a second chance in life.