Histologic Proof That Acellular Dermal Matrices (ADM)—Enduragen, DermaMatrix, and DuraMatrix—Are Not Repopulated or Nonviable and That AlloDerm May Be Repopulated but Degraded Synchronously

I read with interest the study by Cole et al1 in the August 2011 issue of Aesthetic Surgery Journal . The study displays photomicrographs from laboratory work in a murine model, and the authors contributed to our microscopic understanding of degrees of cellular repopulation and postinflammatory resorption of four acellular dermal matrices (ADM): AlloDerm, DermaMatrix, DuraMatrix, and Enduragen (AlloDerm [LifeCell Corp., Branchburg, New Jersey], DermaMatrix [Synthes, Inc., West Chester, Pennsylvania], DuraMatrix [Stryker Corp., Kalamazoo, Michigan], and Enduragen [Stryker Corp., Kalamazoo, Michigan]). It has been shown in the literature that an ideal ADM possesses collagen and extracellular components (glycosaminoglycans, etc); is recognized as host tissue and not as foreign; is repopulated by host stem cells, then macrophages, fibroblasts, and endothelial cells, to revascularize the matrix; and becomes host fibrous or collagen tissue that undergoes the same degradation and limited turnover that human collagen undergoes regularly.2 Yet, the authors of this report seem to (1) support the use of DuraMatrix, DermaMatrix, and Enduragen, which are not repopulated by host cells, and (2) suggest that cross-linking Enduragen and DermaMatrix and irradiating/sterilizing ADM to limit incorporation and degradation by the host may be advantageous in ADM products placed for in-human applications. Plastic surgeons utilize a number of ADM products.3 Despite any vendor claims to the contrary, none of us know for certain which ADM is “best”; we only know which ADM formulas have been studied and published the most or least frequently. In terms of ADM publications, most laboratory or retrospective studies have discussed AlloDerm and Strattice (LifeCell Corp., Branchburg, New Jersey). As yet, there is no medical or histological evidence proving the absolute superiority of one ADM over another. Vendors may claim that their particular ADM is equal or superior to AlloDerm, but we have no long-term, randomized, prospective controlled …