One of the largest allograft processors and suppliers in the country, AlloSource, has recently launched a remarkably robust dermal matrix for challenging cases like superior capsular shoulder reconstruction. This new allograft comes in 3.0-4.0 mm thick acellular dermal matrix (!) forms.
Sometimes You Just Need a 4.0 MM Thick Dermal Graft
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OTW contacted AlloSource, based in Centennial, Colorado, to learn more about this really interesting allograft tissue.
AlloSource told OTW that their ultra-thick acellular dermal matrix was processed in such a way as to ensure that “each allograft’s thickness is consistent throughout the entire graft. The product was designed for use in the repair or replacement of damaged or inadequate tissue required in demanding procedures, such as superior capsule reconstruction. These types of procedures require high suture retention and ultimate tensile strength and AlloMend Ultra-Thick meets those requirements.”
AlloSource’s VP of Sales, Ralph Diaz, explained: “After spending time with our surgeon customers to understand what they needed from a thicker dermal allograft, we worked with our engineering team to implement a proprietary manufacturing process that maximizes the tissue we can use from our donors to consistently achieve the desired thickness for a wide range of surgical applications including complex shoulder reconstructions.”
In order to create the new AlloMend Ultra-Thick product, AlloSource had to develop a proprietary new decellularization method which allowed for skin of this thickness to be fully decellularized. As Ken Hammons, AlloSource’s Operations Senior Manager explained, “Full decellularization is necessary in order to meet the requirements of the product. From there, the tissue is cut to a required thickness using dedicated machinery to minimize variability within the product.”
Surgeon-user Hilary Malcarney, M.D. of Nevada Orthopedics told OTW, “The AlloMend Ultra-Thick Acellular Dermal Matrix graft handles well and allows for easy arthroscopic delivery and suture passing. It looks and feels much thicker and has improved my confidence in reconstructing the superior capsule in the shoulder.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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