The use of Acellular Dermal Matrix (Dermacell) in diabetic chronic wounds

The extracellular matrix (ECM) is an intricate network composed of an array of multidomain macromolecules organized in a cell/tissue-specific manner. Components of the ECM link together to form a structurally stable composite, contributing to the mechanical properties of tissues. The ECM is also a reservoir of growth factors and bioactive molecules. It is a highly dynamic entity that is of vital importance, determining and controlling the most fundamental behaviors and characteristics of cells such as proliferation, adhesion, migration, polarity, differentiation, and apoptosis.[1][2] The ECM provides a structural scaffold via a network of protein–protein and protein–proteoglycan interactions. These interactions are involved in the formation of supramolecular assemblies such as collagen fibrils and elastic fibers, in tissue architecture, and in cell-matrix interactions that regulate cell growth and behavior. The cells and the ECM have a two-way reciprocal relationship.[3][4] Cells produce, secrete, deposit, and remodel ECM to mediate ECM composition and topography. The ECM in turn transmits signals through ECM receptors to influence cell characteristics and activities.[5] Such a feedback mechanism is essential for rapid response of cells to surrounding environmental changes. Human acellular dermal matrices (ADMs) are used successfully in a variety of procedures, including sports medicine related, wound repair, and breast reconstructions, Current treatment strategies for skin wounds/tissue support mostly aim to replace lost tissue rather than support intrinsic self-healing mechanisms. However, new developments within the area of tissue-engineered scaffolds are leading to an ultimate goal of tissue regeneration rather than replacement.[6][7][8][9][14][15]