PURPOSE: Soft tissue coverage of vital structures in patients who are at high risk for extended operative time or poor candidates for flap coverage often poses a difficult challenge to the reconstructive surgeon.  Acellular dermal matrix (ADM) has been used previously for reconstruction of the abdominal wall, areas of full thickness skin loss in burn patients and soft tissue coverage over various vital structures such as tendons and bones. Recent data from burn literature demonstrats that ADM and split thickness skin graft may be used over area of full thickness skin loss in a one step procedure or in serial application.

METHOD: Here, we present a series of 13 consecutive trauma patients where ADM was used in conjunction with a split thickness skin graft as a one or two step procedure to provide soft tissue coverage over exposed bone and across joints.  Patients selected for this procedure where either poor candidates for long surgery or for flap coverage.

RESULTS: Nine of thirteen patients demonstrated 100% take of ADM and split thickness skin graft.  In all successes, the recipient site was meticulously debrided of necrotic tissue and demonstrated complete eradication of infection. The wound was covered with meshed, graftable ADM followed by a skin graft either in a one step procedure or in serial manner.  A negative pressure device was used following grafting.  Three patients had partial loss of the graft due to infection, use of thick acellular dermal matrix and a hematoma, respectively.  One patient demonstrated stable coverage over infected bone for over 2 years, despite orthopedic manipulation, but ultimately demonstrated failure over a portion of the graft site.

CONCLUSION: When indicated, ADM and split thickness skin grafting may be used for the coverage of vital structures in a one-step or two-step procedure.