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 Cymetra is a minimally invasive, injectable form of AlloDerm
- Cymetra is actually a micronized particulate form of AlloDerm. Like AlloDerm, Cymetra contains all the elements needed to replace tissue (collagens, elastin, proteins, and proteoglycans). The collagens and elastin provide structure for cell repopulation, while the proteoglycans and proteins allow the patient’s own cells to initiate revascularization and cell repopulation.
- Because of the small particle size, Cymetra can be delivered by injection as a minimally invasive tissue graft. Like AlloDerm, Cymetra is a natural alternative to using the patient’s own tissue, or to traditional products that act as substitutes for soft tissue. Cymetra is remodeled into normal soft tissue by the body - with a low potential for eliciting an inflammatory response or graft rejection.
- Cymetra is ideally suited for the correction of soft-tissue defects requiring minimally invasive techniques, such as injection laryngoplasty. To learn more about using Cymetra for injection laryngoplasty, read on.
To learn about using AlloDerm for other procedures, click here
To learn about using AlloDerm for grafting procedures, click here
Cymetra—The Ideal Alternative for Injection Laryngoplasty
Procedure for Injection Laryngoplasty with Cymetra
- Explicit rehydration instructions accompany each syringe of Cymetra. All components required for rehydration (except for the normal saline or selected diluent) are provided by Lifecell.
Injection Methods and techniques
- Recommended needle size: 18-23 gauge. The particle size is the limiting factor for needle size. Smaller needles may become clogged. (Do not dilute Cymetra in order to use a smaller needle—dilution may cause leaking from the injection site.)
- Position of injections: Cymetra is injected at the anterior third and the posterior third of the vocal cord—toward the vocal process. Immediate phonation following injection will help distribute the Cymetra evenly across the vocal cord.
Technical Considerations
Transoral- Place the needle transorally into the anterior third of the vocal cord and inject approximately 0.5-0.8cc (or until the Cymetra is visible at the injection site). Withdraw and repeat the injection in the posterior third, near the vocal process. (To avoid losing Cymetra from the needle, pressure on the syringe plunger should be released prior to withdrawing the needle.)
Transcutaneous- Infuse the skin at the treatment line with about 2cc lidocaine (with 1:100,000 epinepherine) and allow time for induction of local anesthesia. If patient is sensitive to either, substitute the proper local anesthetic.
- Locate the midline of the thyroid lamina with an index finger. Approaching from the side to be treated, penetrate the skin with a 1-inch needle (18-23 gauge) attached to the Cymetra syringe about 1mm inferior to the midline of the thyroid lamina and anterior. Pass the needle through the thyroid lamina with a twisting motion, and advance the needle while visualizing the vocal cord through a laryngoscope. Once a bulge can be visualized, withdraw the needle slightly and inject approximately 0.5 - 0.8cc of Cymetra. (To avoid losing Cymetra from the vocal fold, do not allow the needle to penetrate into the airway.)
Reposition the needle more posterior toward the vocal process and repeat injection.
Frequently Asked Questions about Cymetra
Q: Is allergy testing needed with Cymetra?
A: No. The potential of an immune response has been minimized because essentially all of the major histocompatibility antigens I and II cells which mediate human immune response have been removed during processing.
Q: What should be used for rehydration?
A: Cymetra has a unique in-syringe rehydration system. All components needed come in each package. All you supply is the normal saline or selected diluent. Refer to the Directions for Use found in all Cymetra package labeling.
Q: How much Cymetra should be used?
A: This depends on the procedure, the anatomy of the patient, and the desired results. Always discuss desired and possible results with the patient—and adjust amounts accordingly. A progressive buildup of tissue with 2 or 3 treatments over time is recommended. (Caution: Do not save any unused material for later use.)
Q: Are there any procedures in which Cymetra should not be used?
A: Due to particle size, do not use Cymetra in periocular line correction or glabellar contouring. See Directions for Use found in all Cymetra package labeling.
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