Acellular dermal matrix and skin grafts: A long-lasting alternative for weight-bearing zone reconstruction after degloving trauma of the foot

Reconstruction of the weight-bearing surface of the foot presents challenging difficulties due to the unique anatomical properties of the heel and its fundamental cushioning effect. Despite the literature reported several available strategies, an ideal technique for reconstruction of the weight-bearing heel has not yet been elucidated. In the last decade a combined use of acellular dermal matrices, negative pressure wound therapy and skin grafts has been proposed as a reliable and less invasive alternative for complex wounds management. We described 4 cases of severe degloving trauma of the plantar region with massive soft tissue defects of the foot successfully treated trough staged reconstruction with artificial dermis, negative pressure therapy and skin grafts during the period from March 2010 to July 2012. All of them were white Caucasian men with a mean age of 45,2 years (range, 29-55 years). A stable complete healing was obtained in all the patients after a mean time of 63 days (ranging from 58 to 71 days). Follow-up period ranged from 31 to 61 months (mean follow-up, 51,3 months). All patients were able to walk using orthopaedic shoes and they didn’t have immediate postoperative complication such as template infection or unsuccessful skin graft/dermal matrix engraftment. Despite the initial concerns about the use of acellular dermal matrices and skin grafts for this kind of injuries, they seems to be a simple and safe alternative for weight-bearing reconstruction of the degloved foot. The authors believe that the current study yields useful informations and reassurances about their long-term reliability.