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Introduction: Reduction mammoplasty is a common reconstructive and esthetic procedure with variable long-term outcomes regarding breast shape, projection, and nipple–areolar complex. One common complaint is recurrent breast ptosis, which may be mitigated by sufficient support of the inferior pole. This review will look at the effects of mesh in mitigating postoperative ptosis following reduction mammoplasty. Methods: A comprehensive review of the literature was performed using the PubMed database. Manuscripts that provided data with respect to the effects of mesh on cosmetic outcomes, patient-reported outcomes, complications, and surveillance were utilized. Results: Six studies with a total of 634 patients were included in this review. There is limited evidence to support a cosmetic benefit with the use of mesh in reduction mammoplasty patients. While subjective satisfaction was demonstrated in one paper, few others had objective measurements of the impact of mesh. Complications included infection, skin necrosis, and loss of nipple sensation. Mammography was found to not be affected by mesh placement. Discussion: The use of mesh during reduction mammoplasty is a relatively modern innovation that does not appear to have a significantly different risk profile than that of traditional reduction procedures. There is limited cosmetic value based on currently available data. More objective future analysis is necessary in order to justify the use of mesh in reduction mammoplasty for its claimed cosmetic benefits. Level of Evidence III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine Ratings, please refer to Table of Contents or online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Introduction: During cloacal reconstruction, vaginal replacement with an intestinal graft is considered when native vagina does not reach the perineum. Risks include need for revision surgery, mucus production, colitis, and rarely dysplasia. Given these concerns, alternative vaginal reconstructive procedures are being considered. We present a novel case using AlloDerm for vaginal replacement in a female infant undergoing cloacal reconstruction. Case presentation: A 17-month-old female with a complex medical history including Stage 5 chronic kidney disease (CKD) underwent repair of a 4.5 cm cloaca via a posterior sagittal approach. Although the rectum was adequately mobilized off tension, the vagina remained 4 cm from the perineum when off tension. Because vaginal replacement using sigmoid colon would have required exploratory laparotomy in this medically complex child, decision was made to proceed with vaginoplasty using an AlloDerm graft. Two 2 × 4 cm pieces of AlloDermwere placed longitudinally to create the anterior and posterior vaginal walls. The lateral walls and surrounding fat were then secured and the introitus was created. Vaginoscopy was performed three months post-operatively and confirmed an intact graft approximately 2–3 cm long with a patent anastomosis to the native vagina. Conclusion: AlloDerm is an acellular tissue matrix that supports tissue regeneration. This is a promising vaginal replacement option for patients with cloaca who are not good candidates for a colonic vaginoplasty. Future studies are needed to assess long-term outcomes of this graft for prepubertal vaginoplasties.

Alloplastic implants such as acellular dermal matrix (ADM) have been used for various aesthetic and reconstructive purposes since the 1990s. Rhinoplasty addresses both aesthetic and functional nasal impairments, often involving the adoption of grafting materials. Currently, autologous grafts, such as those using septal cartilage, are the gold standard. However, they pose the risk of donor site morbidity, technical challenges, and additional operative time. We review total complications, resorption/re-operation and success rates associated with the use of ADM in rhinoplasty. A literature search was conducted on PubMed, Prospero, DynaMed, DARE, EMBASE and COCHRANE databases. (Registry: CRD42023428019). A total of 462 patients from 15 studies were included, the mean (range) age was 30 (12–65) years, with a female-to-male ratio of 2:1. The most common indications for ADM were for cosmetic (35%, n = 163) and functional rhinoplasty (5%, n = 24). The most common type of ADM used was Alloderm (46%, n = 211). The most common indication for ADM was dorsal nasal augmentation (68%, n = 314). Eleven patients (2%) required revision surgery. The pooled success of ADM in rhinoplasty was 96% (95% CI 94 to 99, p = 0.93; I2 = 0%). 2% of patients developed postoperative complications and no statistically significant difference was seen in complications or success rates when comparing the different types of ADM. ADM in rhinoplasty was associated with fewer complications and re-operation rates, and similar if not less resorption compared to traditional autografts. Therefore, it can be a viable alternative to current autologous grafts in rhinoplasty surgery. [ABSTRACT FROM AUTHOR]

Artificial dermal substitutes (ADMs) have been trialled to improve outcomes at the donor site following the harvesting of a radial forearm free flap (RFFF). This systematic review compares donor site aesthetic and functional outcomes, with the use of an ADM versus conventional practice. The databases Medline, Embase, Cochrane Library, Web of Science (Core Collection), and Scopus were searched for retrospective, prospective, and case-control studies and randomised control trials (RCTs) involving any ADM. Studies with adult patients having undergone RFFF harvesting and donor site repair with an ADM, commenting on appropriate clinical outcomes and without high risk of bias, were included. Direction-of-effect analysis was performed on relevant groupings of studies since heterogeneity in outcome measurement precluded meta-analyses. Across eight non-comparative studies included, 132 patients had donor site coverage with AlloDerm™, Integra™, Matriderm™, or Rapiderm. Across 11 comparative studies included, 240 patients had donor site coverage with fish-skin matrix, AlloDerm™, amniotic membrane, MegaDerm™, Hyalomatrix, Integra™, or Matriderm™. Five out of 11 comparative studies demonstrated superior aesthetic outcomes with ADMs according to at least one aesthetic metric compared to controls, whilst 6/11 demonstrated superior functional outcomes with ADMs. No study demonstrated poorer aesthetic or functional outcomes with an ADM compared to conventional practice. In summary, the lack of studies reporting poorer outcomes with them compared to conventional practices, and a cumulative effect direction in their favour, provide strong indications in support of the use of AlloDerm™, Integra™, or Matriderm™ grafts. Further comparative studies, including RCTs, are needed to reinforce these initial indications. [ABSTRACT FROM AUTHOR]

Aim: This randomized controlled trial aimed to investigate the efficacy of soft‐tissue augmentation (STA) with a subepithelial connective tissue graft (SCTG) or an acellular dermal matrix (ADM) on reducing tissue alterations at an immediate implant site. Materials and Methods: This trial had three groups: (i) immediate implant with SCTG (ICT group); (ii) immediate implant with ADM (IAD group); (iii) immediate implant without STA (control group). Forty‐six patients were randomly assigned to each group. Implants were placed at the maxillary anterior or premolar areas and restored after the 6‐month visit. Clinical outcomes, including buccal soft‐tissue contour, peri‐implant mucosal level, soft‐tissue thickness and keratinized tissue width, were measured at baseline and at 3‐, 6‐ and 12‐month follow‐up visits. Radiographic bone levels were measured at baseline and at 6‐ and 12‐month follow‐up visits. Patient‐reported outcomes were also collected. Results: STA procedures increased peri‐implant mucosal thickness and maintained buccal soft‐tissue contours. Compared to the control group, STA groups did not prevent peri‐implant mucosal recession or interproximal bone resorption. Generally, no significant differences in clinical outcomes were detected between the ICT and IAD groups. Most patients were highly satisfied with the immediate implant procedure and outcomes without significant differences between groups. Conclusions: STA at immediate implant sites enhanced soft‐tissue thickness and maintained soft‐tissue contours but did not prevent peri‐implant mucosal recession or interproximal bone resorption. Long‐term follow‐up should be performed since these results were reported for only up to 1 year. [ABSTRACT FROM AUTHOR]

AlloDerm RTU® and AlloMaxTM are two acellular dermal matrices (ADMs) used in implant-based breast reconstruction. In this study, we examined whether different processing methods for the ADMs lead to a disparity in histologic, clinical, and financial outcomes after breast reconstruction. Thirty patients undergoing implant-based breast reconstruction were randomized into AlloMax or AlloDerm arms (n = 15, each). ADM was placed at the time of immediate reconstruction. Patients were evaluated for complications on postoperative days 7, 14, and 30. During implant exchange, ADM biopsies were taken and compared histologically for vascular and cellular infiltration. Patient satisfaction was evaluated using the BRECON-31 questionnaire 1 year after implant exchange. A cost analysis was performed comparing the two ADMs. Patient demographics and complication rates were similar between the two groups (p > 0.05). Histologically, vessel density and fibroblast/inflammatory cell infiltrate were greater on the dermal side than on the implant side (p  0.05). The BRECON-31 satisfaction questionnaire yielded similar responses across all metrics between the two study arms. The negotiated price was slightly different when comparing the two ADMs, with no significant difference in ADM reimbursement. In this study, AlloDerm RTU and AlloMax were successfully used for implant-based breast reconstruction with comparable outcomes.

During cloacal reconstruction, vaginal replacement with an intestinal graft is considered when native vagina does not reach the perineum. Risks include need for revision surgery, mucus production, colitis, and rarely dysplasia. Given these concerns, alternative vaginal reconstructive procedures are being considered. We present a novel case using AlloDerm for vaginal replacement in a female infant undergoing cloacal reconstruction. A 17-month-old female with a complex medical history including Stage 5 chronic kidney disease (CKD) underwent repair of a 4.5 cm cloaca via a posterior sagittal approach. Although the rectum was adequately mobilized off tension, the vagina remained 4 cm from the perineum when off tension. Because vaginal replacement using sigmoid colon would have required exploratory laparotomy in this medically complex child, decision was made to proceed with vaginoplasty using an AlloDerm graft. Two 2 × 4 cm pieces of AlloDermwere placed longitudinally to create the anterior and posterior vaginal walls. The lateral walls and surrounding fat were then secured and the introitus was created. Vaginoscopy was performed three months post-operatively and confirmed an intact graft approximately 2–3 cm long with a patent anastomosis to the native vagina. AlloDerm is an acellular tissue matrix that supports tissue regeneration. This is a promising vaginal replacement option for patients with cloaca who are not good candidates for a colonic vaginoplasty. Future studies are needed to assess long-term outcomes of this graft for prepubertal vaginoplasties. [ABSTRACT FROM AUTHOR]

Background: Microsurgical technique is a recent advancement in periodontal plastic surgery, which improves the predictability of periodontal procedures, providing better esthetic results with minimal postoperative discomfort. Alloderm is an alternate to connective tissue grafts, which has been successfully used for root coverage. The present study aims at Comparative assessment of Micro and Conventional surgical techniques for root coverage using coronally positioned flap (CPF) with Alloderm. Materials and Methods: Twenty sites with Miller's Class I or II gingival recession defects were selected; sites were randomly divided into control and test groups. Test sites were treated with CPF and acellular dermal matrix (ADM) using Microsurgery and control sites were treated with CPF and ADM using conventional method. Results: Conventional and Microsurgical procedures for root coverage showed a statistically significant difference in all clinical parameters from baseline to 3 and 6 months (P < 0.01). The microsurgical technique demonstrated a significant difference in ultrasonographic thickness of gingiva (P < 0.003) and patient satisfaction score (P < 0.005). Conclusion: Microsurgical procedure for root coverage was found to be superior to the conventional macrosurgical approach under magnification. Microsurgical sites healed faster with neovascularization demonstrated on ultrasonographic evaluation with improved gingival thickness and patient satisfaction scores.

Abstract Background Rates of nipple-sparing mastectomies have increased over the past decade. In 2017, acellular dermal matrix was used in 56% of breast reconstructive procedures, with complication rates similar to operations without AlloDerm. Although persistent nipple discharge after nipple-sparing mastectomy is a rare event, it has been described in the literature. Other authors have described evaluation and treatment on a case-by-case basis. To the best of our knowledge, this is the first case report to describe a persistent unilateral discharge after multiple operative revisions and to provide an algorithmic approach to workup and treatment. Case presentation We present a case of a 29-year-old Hispanic woman with BRCA1 mutation who underwent a prophylactic bilateral nipple-sparing mastectomy with immediate reconstruction using AlloDerm. The year following her operation, the patient underwent two surgical revisions, one for implant rippling and one for asymmetry. Six months after her second revision, she presented to our hospital with a capsular contracture and unilateral clear nipple discharge. Her breast ultrasound showed dilated subareolar ducts and a suspicious mass. Magnetic resonance imaging identified a benign-appearing, rim-enhancing fluid collection. She underwent a third revision. One year later, she returned to our clinic with bloody nipple discharge, erythematous skin changes, and a palpable breast lump. Her surgical biopsy showed a fold in AlloDerm and chronic inflammatory changes. She continued experiencing discharge and opted for nipple excision. During the operation, a lacrimal probe demonstrated a direct connection between the discharging external duct and a seroma associated with an area of unincorporated AlloDerm. The section of unincorporated AlloDerm was excised, and no evidence of malignancy was identified. Ten months later, the patient remained symptom-free and had progressed to placement of final silicone implants. Conclusions To the best of our knowledge, this is the first case report to describe a nongravid patient with persistent unilateral sanguineous nipple discharge after multiple operative revisions. A visible communication between the draining duct and a seroma associated with unincorporated AlloDerm was ultimately identified. We present a clinical algorithm for patients with nipple discharge after nipple-sparing mastectomy.

Mucosal fenestrations are rarely encountered in clinical practice, and as such their management is not often reported. Their treatment might be further complicated due to a communication with the oral environment, making them more susceptible to accumulation of debris, plaque, and calculus, thereby reducing the probability of mucosal renewal. The aim of the present case report is to highlight one such rare clinical scenario and its apt and effective management. Surgical management of an uncommon presentation of concomitant gingival recession with an isolated mucosal fenestration in an atypical location, with an allograft matrix is presented here with 2 years' follow-up. A review of the literature reveals no previous application of AlloDerm graft for the management of a similar situation. [ABSTRACT FROM AUTHOR]

Soft tissue defects resulting from trauma, vascular disease, burns, and postoncologic resections require reconstructive surgery for appropriate wound coverage and support. Dermal substitutes have been applied to a vast array of reconstructive settings across nearly all anatomical areas with demonstrable success. However, they require meticulous handling and operative technical expertise to optimize management of these soft tissue defects. In this review, we will address three dermal substitutes, their operative techniques, and their surgical applications. [ABSTRACT FROM AUTHOR]

The indications for using biologic wound agents have expanded greatly since first being employed for acute burn management. The majority of the literature details the use of said agents in the adult population; however, there is little representation regarding their uses for reconstructing defects typically observed in the pediatric population. Ironically, children, and to a lesser extent adolescents, greatly benefit from their use given the reduced skin laxity and amount of surrounding tissue available for locoregional tissue transfer when compared with adults. Herein, we detail the use of acellular and cellular biologic wound agents in the pediatric population. [ABSTRACT FROM AUTHOR]

Background: The tissue engineering has recently shown a significant progress in the fields of membranes and biosynthetic materials. Advanced platelet-rich fibrin (A-PRF) contains functional molecules that have newly shown great interest in regenerative therapies.The purpose of this study was to evaluate the effect of A-PRF on the adhesion of gingival fibroblast cells and osteosarcoma cells to different membranes. Materials and Methods: In this experimental in vitro study, three collagen, alloderm, and mucograft membranes were studied, which were cut into four 5 mm x 5 mm pieces and placed in the bottom of a 24-well culture medium. One milliliter of A-PRF was added to two wells from each group and the other two wells remained without A-PRF. The gingival fibroblasts and osteosarcoma cells were individually added to each well. The cell adhesion was studied using an electron microscope after 24 h. The data were analyzed by independent t-test, one-way analysis of variance, and least significant difference test. Results: I n the presence of A-PRF, there was a significant higher osteoblast adhesion to collagen membrane compared to alloderm and mucograft membranes (P < 0.001). In the absence of A-PRF, adhesion of osteoblasts to collagen membrane was significantly higher than alloderm and mucograft (P = 0.019). Moreover, in the presence of A-PRF, fibroblast adhesion to collagen membrane was significantly higher than alloderm and mucograft membranes (P < 0.001). Furthermore, in the absence of A-PRF, no significant difference was found among the study groups (P = 0.830). Conclusion: A-PRF was effective on fibroblast adhesion to the collagen membrane, which is similar to its absence. A-PRF was also found to be very effective on the adhesion of fibroblast cells to the collagen membrane, and in its absence, even less adhesion was observed compared to the other membranes. The presence or absence of A-PRF showed no significant differences in both cells' adhesion for alloderm and mucograft membranes. [ABSTRACT FROM AUTHOR]

Hypospadias is a congenital disorder of urethra in which meatus is not at its correct place and occurs in 1 of 250 live male birth. Many techniques have been used for the repair of hypospadias and to decrease the incidence of fistula. Alloderm has been recently used for the repair of urologic congenital defects, and reconstructive surgeries, but not used in hypospadias in a randomized controlled trial. Therefore, the aim of this study was to assess the efficacy of Alloderm® (Regen) to reduce fistula rate in hypospadias repair. This was a randomized controlled trial. Sixty patients were divided into two groups, 30 children underwent surgery using Alloderm® (Regen) as the Alloderm group and 30 without using it as controls. In the Alloderm group, 21 underwent primary surgery (12 mid-shaft hypospadias who underwent concurrent chordee correction and urethroplasty, and 9 penoscrotal who underwent 2 stage surgery, chordee was first corrected and then 6 months later TIP was performed), and 9 underwent fistula repair due to previous surgeries. In the control group, 24 patients underwent primary surgery (15 mid-shaft, and 9 penoscrotal) and 6 fistula repair the same as the Alloderm group but without using Alloderm. There was no meaningful difference between the two groups regarding age (P = 0.634). There was no meaningful difference regarding the operation type between the two groups (P = 0.371). There was no meaningful difference regarding the meatal location between the two groups (P = 0.781). There were no significant post-operative complications in the both groups. No bleeding or diverticulum occurred. Recurrence of fistula occurred in one patient in the Alloderm group after fistula repair and in 2 in the control group. Overall, In the Alloderm group, 3 (2 after TIP and 1 after fistula repair) patients and in the control group 8 (6 after TIP, 2 after fistula repair) patients developed fistulas after surgery (10% vs 26.7%). There was a statistically meaningful difference regarding fistula formation between the two groups using Chi-square test (P = 0.014). Alloderm® (Regen) can be used for hypospadias and fistula repair with very few complications and good results. Fistula was less probably occurred in the Alloderm group compared to the standard repair of hypospadias. [ABSTRACT FROM AUTHOR]

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BackgroundHuman acellular dermal matrices (HADMs) are used in a variety of settings. AlloMax is a new HADM currently being used for breast reconstruction and hernia repair. We compared the in vivo tissue integration of AlloMax to AlloDerm, a well-studied HADM, in rats.MethodsWe implanted AlloDerm and AlloMax patches into subcutaneous pockets on the backs of 32 male Sprague-Dawley rats. The animals were killed after either 4 or 8 weeks, and the patches were recovered and stained for histopathologic analyses. Microscopic end points included patch thickness, vascularization, tissue in-growth, fibroblast proliferation, and inflammation.ResultsAll animals completed the study without complications or infection. There were no significant differences in graft thicknesses at 4 and 8 weeks. Microscopically, at 4 weeks, AlloDerm sections had significantly more microvessels than AlloMax (P = 0.02). This disparity increased by 8 weeks (P < 0.01). Similarly, we found greater tissue in-growth and fibroblast proliferation in AlloDerm than AlloMax sections at 4 (P < 0.01) and at 8 (P < 0.01) weeks. Inflammatory infiltrates consisted of lymphocytes, histiocytes, eosinophils, and plasma cells. Deep graft infiltration by predominately lymphocytic inflammatory cells was significantly higher in AlloDerm than AlloMax grafts at 4 (P = 0.01) and 8 (P = 0.02) weeks. Graft necrosis was uncommon, but marginal fibrosis was similar in both.ConclusionsAlloDerm grafts had greater neovascularization, tissue infiltration, fibroblast proliferation, and inflammatory reaction than AlloMax grafts when placed subcutaneously in rats. AlloDerm may be better incorporated than AlloMax when placed in vivo.

Background: Microsurgical technique is a recent advancement in periodontal plastic surgery, which improves the predictability of periodontal procedures, providing better esthetic results with minimal postoperative discomfort. Alloderm is an alternate to connective tissue grafts, which has been successfully used for root coverage. The present study aims at Comparative assessment of Micro and Conventional surgical techniques for root coverage using coronally positioned flap (CPF) with Alloderm. Materials and Methods: Twenty sites with Miller's Class I or II gingival recession defects were selected; sites were randomly divided into control and test groups. Test sites were treated with CPF and acellular dermal matrix (ADM) using Microsurgery and control sites were treated with CPF and ADM using conventional method. Results: Conventional and Microsurgical procedures for root coverage showed a statistically significant difference in all clinical parameters from baseline to 3 and 6 months (P < 0.01). The microsurgical technique demonstrated a significant difference in ultrasonographic thickness of gingiva (P < 0.003) and patient satisfaction score (P < 0.005). Conclusion: Microsurgical procedure for root coverage was found to be superior to the conventional macrosurgical approach under magnification. Microsurgical sites healed faster with neovascularization demonstrated on ultrasonographic evaluation with improved gingival thickness and patient satisfaction scores. [ABSTRACT FROM AUTHOR]

The reconstruction of abdominal wall defects can be a challenging procedure because it needs to restore musculofascial integrity, avoid causing incisional hernias, and secure the visceral organs. We successfully reconstructed a large abdominal fascial and peritoneal defect using a layer-by-layer method involving a rectus abdominis muscle flap and acellular dermis (AlloDerm®). [ABSTRACT FROM AUTHOR]

With increase in esthetic expectations, the treatment of gingival recessions has gained importance in last few years. The aim of this treatment is to cover root surface and gain satisfactory esthetical results. Today there are many surgical methods available for this purpose. The use of sub-epithelial connective tissue graft with coronal position flap is the gold standard in the treatment of gingival recessions. However, there are some drawbacks, such as limited donor area of sub-epithelial connective tissue graft and existence of the second operational area. In order to overcome these disadvantages, acellular dermal matrixes are used in periodontal plastic surgeries as alternatives to autogenous grafts. In single tooth Miller Class I and Class II gum recessions, the best predictable results can be obtained by sub-epithelial connective tissue grafts. In addition to this, the use of acellular dermal matrix along with coronal position flap can be evaluated as an alternative for autogenous donor area.

Although controversial, the use of acellular dermal matrices (ADMs) for abdominal wall reconstruction (AWR) is increasing. There are now many different ADMs available, but there is a lack of studies directly comparing ADMs in terms of outcomes. A retrospective chart review was performed to compare perioperative wound complications (up to 120 d postoperatively) between patients who underwent AWR with the human noncrosslinked ADMs Alloderm or Cortiva from January 2012 to March 2020. Surgical technique uniformly consisted of open component separation, onlay implantation of ADM, and progressive tension suture fixation of ADM. After exclusions, 53 patients were in the Alloderm group, and 29 patients were in the Cortiva group. The overall perioperative wound complication rate between Alloderm (51.92%) and Cortiva (72.41%) was not significantly different (P = 0.09921). The average follow-up for Alloderm was 76.69 ± 29.52 d and for Cortiva was 66.93 ± 35.16 d (P = 0.2088). There were no cases that required explantation of ADM. Given the similar perioperative wound complication profiles, the more cost-effective ADM may be a consideration for use in AWR. The fact that there were zero instances of ADM explantation also supports the use of ADM in these high-risk cases. [ABSTRACT FROM AUTHOR]

Introduction: Soft tissue grafts are used around dental implants for different purposes. Autogenous soft tissue graft techniques have yielded favorable results. However, these techniques increase the duration of surgery and postoperative complications. Allogeneic and xenogeneic tissues have advantages over autogenous grafts. Numerous studies have reported successful treatment outcomes with acellular dermal matrix (ADM) as an alternative to autogenous soft tissue for treating mucogingival defects around dental implants. This study aimed to review various soft tissue techniques around dental implants. Materials & Methods: In this systematic review, a search was run in four databases, including PubMed, Scopus, Web of Science, and Cochrane until January 2020 with these key words: soft tissue augmentation, dental implants, keratinized gingiva and acellular dermal matrix. Results: Autogenous connective tissue graft is the gold standard technique for increasing the thickness of soft tissue around dental implants. The use of allogeneic materials as an alternative to these tissues is associated with some advantages. Conclusion: ADM is a suitable alternative for autogenous connective tissue grafts to increase the thickness and width of keratinized tissue around dental implants. [ABSTRACT FROM AUTHOR]

Introduction: The use of decompressive craniectomy in children is controversial and often reserved for patients with refractory intracranial hypertension. Following decompression, skin closure in select cases can be challenging due to brain herniation and swelling through the craniectomy defect. In these cases, partial cortical debridement is sometimes performed. Methods: We describe two cases in which a synthetic skin substitute was used to facilitate a tension-free closure, rather than performing a partial lobectomy. Results: At 6-month follow-up, both patients are at preoperative cognitive baseline, with some residual hemiparesis. Discussion: We believe that use of a synthetic skin substitute for skin closure after decompression is a suitable option for closure of traumatic scalp wounds and may contribute to improved functional outcome in patients with severe intraoperative brain swelling. [ABSTRACT FROM AUTHOR]

Tissue engineering scaffolds are intended to provide mechanical and biological support for cells to migrate, engraft and ultimately regenerate the tissue. Development of scaffolds with sustained delivery of growth factors and chemokines would enhance the therapeutic benefits, especially in wound healing. In this study, we incorporated our previously designed therapeutic particles, composed of fusion of elastin‐like peptides (ELPs) as the drug delivery platform to keratinocyte growth factor (KGF), into a tissue scaffold, alloderm. The results demonstrated that sustained KGF–ELP release was achieved and the bioactivity of the released therapeutic particles was shown via cell proliferation assay, as well as a mouse pouch model in vivo, where higher cellular infiltration and vascularization were observed in scaffolds functionalized with KGF–ELPs. [ABSTRACT FROM AUTHOR]

Our understanding of empty nose syndrome (ENS) continues to evolve. Prior studies evaluating airway augmentation to treat ENS did not use validated disease-specific questionnaires, making the true impact of these surgeries unclear. We present a case series of 10 patients with ENS (11 procedures) who underwent the inferior meatus augmentation procedure (IMAP) between September 2014 and May 2017. Subjective outcomes of IMAP included comparisons of preoperative and postoperative assessments (1 week, 1 month, 3 months, 6 months) using the Empty Nose Syndrome 6-item Questionnaire (ENS6Q), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder 7-item Scale (GAD-7), and Sino-Nasal Outcome Test-22 (SNOT-22). The decrement in ENS6Q scores observed maintained statistical significance at 6 months (P ≤ .001). Similar results were achieved with PHQ-9, GAD-7, and SNOT-22 (P ≤ .01, P ≤ .01, P ≤ .001, respectively). IMAP can dramatically improve the quality of life of ENS patients regarding both ENS-specific symptoms and psychological well-being. [ABSTRACT FROM AUTHOR]

Background: Acellular dermal allograft (AlloDerm) and cartilage perichondrium are two common materials used for repair of tympanic membrane perforations (TMPs). To date, comparative evaluations of their efficacy have rarely been reported. Aim/objectives: To compare anatomical and audiological outcomes between AlloDerm and cartilage perichondrium in type I tympanoplasty. Methods: A total of 61 patients of TMP were studied. In total, 27 patients (Group 1) underwent AlloDerm myringoplasty, and the remaining 34 patients (Group 2) underwent perichondrium myringoplasty. Operating time, closure rate and hearing gain were compared between Groups 1 and 2. Results: Successful closure rates at 6-month follow-up were 88.9% (Group 1) and 82.4% (group 2). The average improvement of air-bone gap (ABG) was 13.5 ± 11.8 dB for Group 1 and 13.1 ± 13.1 dB for Group 2. The difference in between preoperative and 6 months postoperative ABG values was statistically significant (p <.001). Conclusions and significance: Success rates and improvement of hearing level were similar for the AlloDerm (Group 1) and the cartilage perichondrium (Group 2) groups. However, AlloDerm requires shorter operative time and avoids the incisions in the harvest of allografts. Our results suggest that AlloDerm can be recommended as an attractive alternative to cartilage grafts. [ABSTRACT FROM AUTHOR]

Background: Empty nose syndrome (ENS) is a debilitating condition associated with inferior turbinate tissue loss. Surgical augmentation of the inferior meatus has been proposed to treat ENS, although efficacy data with validated, disease‐specific questionnaires is limited. Instead we evaluated submucosal injection of a transient, resorbable filler into the inferior meatus to favorably alter nasal aerodynamics in ENS patients. Methods: Patients with a history of inferior turbinate reduction, diagnosed with ENS via Empty Nose Syndrome 6‐Item Questionnaire (ENS6Q) and cotton testing, were enrolled and underwent submucosal injection of carboxymethylcellulose/glycerin gel (Prolaryn®) into the inferior meatuses between July 2014 and May 2018. This material likely resorbs over several months. Outcomes included comparisons of preinjection and postinjection symptoms at 1 week, 1 month, and 3 months using the ENS6Q, 22‐item Sino‐Nasal Outcome Test (SNOT‐22), Generalized Anxiety Disorder 7‐item scale (GAD‐7), and Patient Health Questionnaire‐9 (PHQ‐9). Results: Fourteen patients underwent injections. Mean ENS6Q scores significantly decreased from baseline at 1 week (20.8 vs 10.5; p < 0.0001), and remained reduced but upward‐trending at 1 month (13.7, p = 0.002) and 3 months (15.5, p > 0.05) following injections. Mean SNOT‐22 scores significantly decreased at 1 week (p = 0.01) and 1 month (p = 0.04), mean GAD‐7 at 1 month (p = 0.02) and 3 months (p = 0.02), and mean PHQ‐9 at 1 week (p = 0.01) and 1 month (p = 0.004) postinjection. Conclusion: Transient, focal airway bulking via submucosal filler injection at sites of inferior turbinate tissue loss markedly benefits ENS patients, suggesting that aberrant nasal aerodynamics from inferior turbinate tissue loss contributes to (potentially reversible) ENS symptoms. [ABSTRACT FROM AUTHOR]

Background: The tissue engineering has recently shown a significant progress in the fields of membranes and biosynthetic materials. Advanced platelet-rich fibrin (A-PRF) contains functional molecules that have newly shown great interest in regenerative therapies. The purpose of this study was to evaluate the effect of A-PRF on the adhesion of gingival fibroblast cells and osteosarcoma cells to different membranes.Materials and Methods: In this experimental in vitro study, three collagen, alloderm, and mucograft membranes were studied, which were cut into four 5 mm × 5 mm pieces and placed in the bottom of a 24-well culture medium. One milliliter of A-PRF was added to two wells from each group and the other two wells remained without A-PRF. The gingival fibroblasts and osteosarcoma cells were individually added to each well. The cell adhesion was studied using an electron microscope after 24 h. The data were analyzed by independent t-test, one-way analysis of variance, and least significant difference test.Results: In the presence of A-PRF, there was a significant higher osteoblast adhesion to collagen membrane compared to alloderm and mucograft membranes (P < 0.001). In the absence of A-PRF, adhesion of osteoblasts to collagen membrane was significantly higher than alloderm and mucograft (P = 0.019). Moreover, in the presence of A-PRF, fibroblast adhesion to collagen membrane was significantly higher than alloderm and mucograft membranes (P < 0.001). Furthermore, in the absence of A-PRF, no significant difference was found among the study groups (P = 0.830).Conclusion: A-PRF was effective on fibroblast adhesion to the collagen membrane, which is similar to its absence. A-PRF was also found to be very effective on the adhesion of fibroblast cells to the collagen membrane, and in its absence, even less adhesion was observed compared to the other membranes. The presence or absence of A-PRF showed no significant differences in both cells' adhesion for alloderm and mucograft membranes.

Objectives  AlloDerm is an acellular dermal matrix often used for reconstruction throughout the body. AlloDerm has been shown to undergo revascularization when used to reconstruct soft tissue such as in abdominal wall reconstruction. In this study, the authors review the literature on revascularization of AlloDerm and demonstrate the histologic findings of AlloDerm after implantation during skull base reconstruction. Study Design  Literature review and case reports. Setting  Tertiary Care Institution Participants  Patients from a tertiary care institution Main Outcome Measures  Histologic slides are evaluated and compared with nonimplanted AlloDerm. Methods  The authors review a case of explanted AlloDerm that had been used for skull base reconstruction after endoscopic skull base surgery. Results  Upon reviewing the histologic slides of explanted AlloDerm to nonimplanted AlloDerm, we demonstrate revascularization of AlloDerm when used in skull base reconstruction. Representative slides will be included. Conclusions  AlloDerm undergoes revascularization when used for skull base reconstruction. [ABSTRACT FROM AUTHOR]

Objective: The current review and survey aim to assess the effectiveness of acellular dermal matrix (ADM) in the repair of cleft palate and oronasal fistula and to evaluate the current trends of ADM use in palate surgery. Design: A systematic review of English articles was conducted using MEDLINE (1960 to July 1, 2016), the Cochrane Controlled Trials Register (1960 to July 1, 2016), and EMBASE (1991 to July 1, 2016). Additional studies were identified through a review of references cited in initially identified articles. Search terms included "cleft palate," "palatal," "oronasal fistula," "acellular dermal matrix," and "Alloderm®." An online survey was disseminated to members of the American Cleft Palate-Craniofacial Association to assess current trends in ADM use in palate surgery. Study Selection: All studies evaluating the outcome of primary palate repair or repair of oronasal fistula with the use of aceullar dermal matrix products were included in the review. Results: Twelve studies met inclusion criteria for review. Studies were generally of low quality, as indicated by methodological index for non-randomized studies (MINORS) scores ranging from 7 to 14. The pooled estimate for fistula formation after primary palatoplasty following ADM use was 7.1%. The pooled estimate for recurrence of fistula after attempted repair using ADM was 11%. Thirty-six cleft surgeons responded to the online survey study. Of these, 45% used ADM in primary cleft palate repair, while 67% used ADM for repair of oronasal fistulae. Conclusion: Use of ADM products is commonplace in palate surgery. Despite this, there is a paucity of high-quality data demonstrating benefit. Further randomized controlled trials examining ADM in palate surgery are required to help develop structured guidelines and improve care. [ABSTRACT FROM AUTHOR]

Background Expansile duraplasty is frequently performed during Chiari I decompression. Aseptic and bacterial meningitis are possible complications of this procedure. We sought to compare the rates of meningitis and subsequent need for cerebrospinal fluid (CSF) diversion with duraplasty using bovine pericardial (BPC) xenograft and allograft. Methods We conducted a retrospective review of 112 patients who underwent Chiari I decompression. All patients underwent duraplasty with either allograft or BPC. Occurrence of postoperative lumbar punctures and associated data were recorded to determine rates of meningitis. Rates of subsequent shunting were also recorded. Results Overall, 112 patients were included in the study: 30 underwent duraplasty with allograft (27%) and 82 received BPC (73%). A total of 26 patients developed postoperative meningitis (23 cases of chemical meningitis and 3 of bacterial meningitis). Rates of meningitis were higher in patients who received BPC than patients who received allograft (28% vs. 10%, respectively; P = 0.047). The rate of shunting was greater in patients with meningitis compared with patients without meningitis (56.5% vs. 5.75%, respectively; P < 0.0001). Moreover, 13 of the 15 patients (87%) in the BPC cohort who were shunted were found to have meningitis compared with 0 of the 3 shunted patients (0%) in the allograft cohort (P = 0.044). Conclusions We found that rates of total meningitis were greater in patients who underwent Chiari I decompression and duraplasty with BPC compared with an allograft. The rate of shunting was significantly higher for patients who developed meningitis after decompression compared with patients without meningitis. Highlights • Chemical meningitis after duraplasty for Chiari I malformation is a well-documented complication. • A wide array of grafts have been used ranging from host-specific pericranium to xenograft, such as BPC. • We compared the risk of chemical meningitis and subsequent need for ventriculoperitoneal shunting in allograft and BPC. • Patients who had duraplasty with BPC had a higher rate of chemical meningitis than those who had duraplasty with allograft. • Patients with chemical meningitis were at higher risk of failing medical treatment and requiring permanent CSF diversion. [ABSTRACT FROM AUTHOR]

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Aim: Evaluation of root length coverage obtained clinically following use of acellular dermal matrix allograft (alloderm®) in the treatment of class I recession. Methods: The present study included ten individuals who had class I gingival recession on the labial aspect of anterior teeth. Acellular matrix allograft (Alloderm®) was used in this study for gingival recession coverage. Lengh of gingival recession was recorded preoperatively at the time of surgery and post-operatively at 2nd, 4th, 12th and 24th week. Obtained data was statically analyzed. Results: When comparison of mean preoperative and post-operative length of recession (in mm) was done at 180 days all patients showed highly statically significant (p< 0.01) decrease in length of recession from preoperative value. When comparison of mean length of recession was done at 90 and 180 days there was no statically significant (p>0.05) difference in length of recession at 180 days from 90 days. Conclusion: Within the limits of this clinical study the Acellular dermal matrix allograft Alloderm®, is a useful and predictable surgical technique for treatment of gingival recessions. [ABSTRACT FROM AUTHOR]

Background: Tissue engineering represents very exciting advances in regenerative medicine; however, periodontal literature only contains few reports. Emdogain (EMD) consists of functional molecules that have shown many advantages in regenerative treatments. This study investigated EMD effect on gingival fibroblast adhesion to different membranes. Materials and Methods: Two dense polytetrafluoroethylene membranes (GBR-200, TXT-200), Alloderm and a collagenous membrane (RTM Collagen) were used in this experimental study. Each membrane was cut into four pieces and placed at the bottom of a well in a 48-well plate. 10 μg/mL of EMD was added to two wells of each group.Two wells were left EMD free. Gingival fibroblasts were seeded to all the wells. Cell adhesion was evaluated by means of a Field Emission Scanning Electron Microscope after 24 hours incubation. Data was analyzed by independent t-test, one-way and two-way ANOVA and post hoc LSD test. P < 0.05 in independent t-test analysis and P < 0.001 in one-way ANOVA, two-way ANOVA and post hoc LSD analysis was considered statistically significant. Results: Alloderm had the highest cell adhesion capacity in EMD+ group and the difference was statistically significant (P < 0.001). In EMD- group, cell adhesion to TXT-200 and Alloderm was significantly higher than GBR-200 and collagenous membrane (P < 0.001). Conclusion: This study showed that EMD may decrease the cell adhesion efficacy of GBR-200, TXT-200 and collagenous membrane but it can promote this efficacy in Alloderm. It also showed the composition of biomaterials, their surface textures and internal structures can play an important role in their cell adhesion efficacy.

Background Acellular dermal matrix (ADM) allografts and their putative benefits have been increasingly described in prosthesis based breast reconstruction. There have been a myriad of analyses outlining ADM complication profiles, but few large-scale, multi-institutional studies exploring these outcomes. In this study, complication rates of acellular dermis-assisted tissue expander breast reconstruction were compared with traditional submuscular methods by evaluation of the American College of Surgeon's National Surgical Quality Improvement Program (NSQIP) registry. Methods Patients who underwent immediate tissue expander breast reconstruction from 2006-2010 were identified using surgical procedure codes. Two hundred forty tracked variables from over 250 participating sites were extracted for patients undergoing acellular dermis-assisted versus submuscular tissue expander reconstruction. Thirty-day postoperative outcomes and captured risk factors for complications were compared between the two groups. Results A total of 9,159 patients underwent tissue expander breast reconstruction; 1,717 using acellular dermis and 7,442 with submuscular expander placement. Total complications and reconstruction related complications were similar in both cohorts (5.5% vs. 5.3%, P=0.68 and 4.7% vs. 4.3%, P=0.39, respectively). Multivariate logistic regression revealed body mass index and smoking as independent risk factors for reconstructive complications in both cohorts (P

The aim of the randomized controlled single blind study is to evaluate the treatment of Miller′s class II gingival recessions by coronally positioned flap (CPF) with or without acellular dermal matrix allograft (ADMA). Ten patients with 20 sites with maxillary bilateral Miller′s class II facial recession defects were selected randomly into two groups of test (ADMA+CPF) and control (CPF alone) group with each group having 10 recession defects to be treated. The clinical parameters included plaque index (PI), gingival index (GI), probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), recession width (RW), height of the keratinized tissue (HKT), and thickness of the keratinized tissue (TKT). These measurements were recorded at baseline and after 6 months post-surgery. Statistical analysis was made by the paired "t" test for intragroup and intergroup comparison was done by the unpaired "t" test. The percentage of root coverage for both the experimental and control groups were 82.2% and 50%, respectively. The changes from baseline to 6 months were significant in both the groups for PD, CAL, and RH; however, for parameters such as RW, HKT, and TKT significance was seen only in the experimental group. On comparison between two groups, only TKT showed statistically significance. It can be concluded that the amount of root coverage obtained with ADMA + CPF was superior compared to CPF alone.

"nBackground and Aim: The usage of free gingival grafts for vestibuloplasty is a routine procedure. The free gingival procedure requires harvesting the graft from a donor site which increases morbidity and the risk of surgical complications. In addition, adequate amount of donor tissue may not be available. Acceptable results of Alloderm application as a substitute for autogenous soft tissue grafts are: Not exposing the patient to an additional surgery, no donor site morbidity, unlimited availability, decreasing the bleeding during the surgery, decreasing the surgical complications, and better color match. The aim of this study was to evaluate the maintenance of the vestibular depth in vestibuloplasty with mucosal graft and Alloderm."nMaterials and Methods: Both methods of anterior mandibular vestibuloplasty by Clark, utilizing Alloderm and mucosal grafts, were employed in ten clinical cases. During the surgeries, half the prepared recipient sites received Alloderm, while the remaining half received autografts in a randomized fashion. Immediately, 1, 3, and 6 months postoperatively, the variables of graft rejection, depth of vestibule and the degree of relapse were evaluated. SPSS software was used for analysis of the data and the methods used for "statistical tests" were as follows: Friedman Method, Paired sample t-test, Smirnov-kolmogrove Method. (The statistical significance level was established at P-value0.05). Similar results were achieved for the mean difference of depth of the vestibule."nConclusion: In patients undergoing Vestibuloplasty, Alloderm could be material of choice to be utilized as autogenic soft tissue grafts in pre-prosthesis procedures.

Background: This article reports on the current use of acellular dermal matrix in breast reconstruction. Methods: A literature review of articles on acellular dermal matrix in breast reconstruction from January 1, 2010, through December 20, 2016, was performed and analyzed for trends in acellular dermalmatrix use and differences between commonly used acellular dermal matrixes. Findings: Clinical findings varied but include improved cosmesis and more 1-stage reconstructions using acellular dermal matrix. Superiority of sterile versus aseptic acellular dermal matrixes was noted, and the increased incidence of red breast syndrome with AlloDerm was significant. The cost-effectiveness of acellular dermal matrix use despite increased upfront costs was also highlighted. Finally, the article emphasizes the importance of well-vascularized mastectomy flaps and the use of indocyanine green angiography as an adjunct in immediate reconstruction with acellular dermal matrix. [ABSTRACT FROM AUTHOR]

Objective: Benchtop methods were evaluated for preclinical inflammation/capsule formation correlation following implantation of human acellular dermal matrices. Methods: Dermal matrices were compared with native dermis for structure (histology, scanning electron microscopy), collagen solubility (hydroxyproline), enzymatic susceptibility (collagenase), and thermal stability (differential scanning calorimetry). Results were compared with implantation outcomes in a primate tissue expander model. Results: Native dermis, electron beam-sterilized, and freeze-dried human acellular dermal matrices had equivalent morphology, acid-soluble collagen (60.5% ± 6.3%, 65.3% ± 3.2%, and 63.3% ± 2.4%, respectively), and collagenase resistance. Implant results showed minimal inflammation/matrix degradation, lack of capsule formation, insignificant elastic modulus change (57.65 ± 20.24 MPa out-of-package/44.84 ± 23.87 MPa in vivo), and low antibody induction (2- to 8-fold increase) for electron beam-sterilized matrix. Similar results for freeze-dried dermal matrix were previously observed. γ - Irradiated, γ-irradiated/freeze-dried, and ethanol-stored dermal matrices were statistically different from native dermis for acid-soluble collagen (82.4% ± 5.8%, 72.2% ± 6.2%, and 76.8%±5.0%, respectively) and collagenase digestion rate, indicatingmatrix damage. γ-Irradiated matrix-implanted animals demonstrated elevated inflammatory response, foreign body giant cells, capsule formation at the tissue expander junction, and robust matrix metalloproteinase-1 staining with significant elastic modulus decrease (37.43 ± 7.52 MPa out-of-package/19.58 ± 1.16 MPa in vivo). Antibody increase (32- to 128-fold) was observed 6 to 10 weeks following γ-irradiated matrix implantation. Ethanol-stored dermal matrix elicited an acute antibody response (4- to 128-fold increase, 2-4 weeks) and macrophage-concentrated synovial-like hyperplasia at the tissue expander junction, moderate matrix metalloproteinase-1 staining, and significant elastic modulus decrease (61.15 ± 9.12 MPa out-of-package/17.92 ± 4.02 MPa in vivo) by 10 weeks implantation. Conclusion: Demonstrated loss of collagen integrity in vitro may be predictive of inflammation/capsule formation in primate tissue expander models. These results may be further predictive of clinical observations. [ABSTRACT FROM AUTHOR]

Cosmetic concern is on increase in dental patients these days resulting in more demand for periodontal plastic surgical procedures. Gingival recession is one of the common problems which impairs aesthetic and may result in hypersensitivity and increase chances of root caries. Several plastic procedures are available to correct the defect. Double papilla laterally positioned flap combined with Alloderm has been used to cover single tooth class I recession site as adequate width of keratinized gingiva is present on adjacent teeth. The technique has resulted in 80% of root coverage.

The objective of this study was to compare the 2 leading human acellular dermal matrices in breast reconstruction with implants. This retrospective study draws on the experience of 2 expert surgeons with a history of long-standing use of the Alloderm-RTU (LifeCell Corporation, Branchburg, NJ) product who switched to the DermACELL acellular dermal matrix (LifeNet Health, Virginia Beach, Va) product. The consecutive nature of these data over this change allowed comparison between the 2 products without the confounding effects of patient selection or change in technique. The postoperative complications of seroma, infection, implant loss, and unplanned return to the operating room were studied, and no statistical differences were noted between these 2 products. The overall complications rates were low, with implant loss and infection less than 2% in 249 cases. Recommendations are for continued use of acellular dermal matrix in breast reconstruction and product selection based on price and availability. [ABSTRACT FROM AUTHOR]

The article describes a case study on durable inguinal ligament reconstruction using bone anchors following oncologic resection. Topiccs covered include the methods used in preparing and evaluating six patients with pelvic tumor, details relating to the reconstruction operation performed on the patients, and details relating to the findings obtained from the evaluated patients. It also discusses the advantages of the proposed technique in re-creating inguinal ligament using bone anchors.

Background Acellular dermal matrix (ADM) is widely used for structural or dermal replacement purposes. Given its innate biocompatibility and its potential to vascularize, we explored the possibility of ADM to function as a small interfering RNA (siRNA) delivery system. Specifically, we sought to improve ADM vascularization by siRNA-mediated inhibition of prolyl hydroxylase domain-2 (PHD2), a cytoplasmic protein that regulates hypoxia inducible factor-1α, and improve neovascularization. Materials and methods Fluorescently labeled siRNA was used to rehydrate thin implantable ADM. Pharmacokinetic release of siRNA was determined. Twelve millimeter sections of ADM reconstituted with PHD2 siRNA (nonsense siRNA as control) and applied to dorsal wounds of 40 FVB mice. Grafts were sewn in, bolstered, and covered with occlusive dressings. Photographs were taken at 0, 7, and 14 d. Wounds were harvested at 7 and 14 d and analyzed (messenger RNA, protein, histology, and immunohistochemistry). Results Release kinetics was first-order with 80% release by 12 h. By day 14, PHD2-containing ADM appeared viable and adherent, whereas controls appeared nonviable and nonadherent. Real-time reverse transcription-polymerase chain reaction demonstrated near-complete knockdown of PHD2, whereas vascular endothelial growth factor and FGF-2 were increased 2.3- and 4.7-fold. On enzyme-linked immunosorbent assay, vascular endothelial growth factor was increased more than fourfold and stromal cell-derived factor doubled. Histology demonstrated improved graft incorporation in treated groups. Immunohistochemical demonstrated increased vascularity measured by CD31 staining and increased new cell proliferation by denser proliferating cell nuclear antigen staining in treated versus controls. Conclusions We concluded that ADM is an effective matrix for local delivery of siRNA. Strategies to improve the matrix and/or genetically alter the local tissue environment can be envisioned. [ABSTRACT FROM AUTHOR]

Background: Autologous pericranium, fascia lata (either as autograft or allograft), bovine pericardium (DuraGuard), fetal bovine tissue (Durepair), processed collagen matrix (DuraGen), and synthetic fabrics (e.g., synthetic Goretex graft) have all been used for duraplasty in Chiari decompression surgery, and no consensus exists as to the optimal material. We reviewed our experience to compare the incidence of graft-related complications associated with using acellular human dermis allograft (AlloDerm) with those of DuraGuard, DuraGen, and Durepair. Methods: In a retrospective cohort chart review, our cohort included 119 patients who underwent 128 Chiari decompression procedures by a single surgeon from January 1, 1997, through July 31, 2012. Age, sex, smoking status, weight, and the type of dural graft used were analyzed with univariate statistical tests. Dural grafts were selected based on the commercial products available at the time of surgery during this 15-year period. Results: The reoperation rate for cerebrospinal fluid leak causing pseudomeningocele was 2.2 % (1/46 cases) with the AlloDerm graft and 17.1 % (14/82 cases) with other materials ( p = 0.01). Each of the non-AlloDerm grafts had a higher reoperation rate than AlloDerm when analyzed separately. Not using AlloDerm was the only statistically significant factor for the need for reoperation ( p = 0.01). Conclusions: The use of the AlloDerm dural graft for duraplasty in Chiari decompressions resulted in a significantly lower pseudomeningocele formation than the use of any other type of dural graft. There was no association between patient age, sex, extra weight, or smoking status and the need for reoperation. [ABSTRACT FROM AUTHOR]