Acellular Dermal Matrices Vs. Autologous Reconstruction in Complex Wounds: A Critical Review of Clinical Outcomes and Cost-Effectiveness

Managing complex wounds with significant tissue loss and avascular exposure traditionally requires autologous tissue transfer. Acellular dermal matrices (ADMs) have fundamentally changed the reconstructive paradigm, providing a biological scaffold that minimizes donor-site morbidity. Nonetheless, increasing utilization of ADMs needs careful examination regarding their clinical complication profiles and economic viability. We undertook a critical review of relevant recent literature (2022–2026) to compare ADMs against autologous reconstruction based on summaries of observational studies, randomized controlled trials, and meta-analyses. The primary endpoints examined were complications at the surgical site, healing trajectories, and decision-analytic cost-effectiveness measures. On the topic of implant-based breast reconstruction, prepectoral ADM utilization correlates with much higher odds of surgical site infection (OR 7.62 versus autologous dermal flaps), generating an increase in cost-utility ratio > $261,720/QALY. Conversely, in chronic wound care, ADMs show strong clinical improvements, reducing the time to closure of diabetic foot ulcers by an average of 48.8 days and reducing aggregate outpatient treatment costs from $5,542 to $2,928 per episode. ADMs are heavily context-dependent in clinical utility and cost. They are highly cost-effective and limb-salvaging adjuncts to surgical intervention for chronic and traumatic defects, and the common practice of performing clean reconstructive surgery for these patients should be critically compared with the lower complication rates and better economic performance of autologous alternative tissue.