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AlloDerm in the OR

 With more than 1 million successful implants and grafts to date, AlloDerm supports rapid revascularization, remodeling and transition to functional host tissue… resulting in tissue that behaves like the original tissue.

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Implanting AlloDerm in the OR
To Rehydrate AlloDerm

When preparing to use AlloDerm in the operating room (OR), the following rehydration procedure should begin early enough to allow for adequate rehydration prior to intended implantation.

For best results when rehydrating AlloDerm, use liberal amounts of warmed saline solution (up to 37°C) in a two-step bath with light agitation.

Normal rehydration of AlloDerm is usually accomplished in 10-40 minutes, depending on thickness.

Equipment required:
  • 2 sterile dishes (e.g., kidney dishes)
  • Sterile normal saline or sterile lactated Ringer's solution that is sufficient to completely submerge the product
  • Sterile atraumatic forceps
Rehydration Step 1:
  • Tear open outer foil bag at the notch and remove inner peel-pouch. (Keep both the foil bag and peel-pouch OUT of the sterile field.)
  • With AlloDerm tissue aseptically removed from its peel-pouch packaging (backing left on), place in first bath of saline solution.
  • For tissue less than 21cm², use at least 50ml of rehydration fluid per sheet. For tissue greater than 21cm², use 100ml per sheet.

    Tip: Warming saline up to 37°C and using gentle movement of AlloDerm in the solution speeds the rehydration process. However, do not heat saline above 37°C.

    Tip: When rehydrating multiple pieces, ensure the pieces are not touching or clumping together as this may slow down the process. Use multiple bowls if necessary.
  • Submerge the tissue completely and soak for a minimum of 5 minutes or until the backing separates from the AlloDerm.

    Tip:     Keep AlloDerm fully submerged by weighing it down, e.g. with sterile forceps.
Rehydration Step 2:
  • Using sterile gloves or forceps, remove and discard the backing once it separates from the tissue. Then, aseptically transfer the tissue to a second bath filled with at least 50ml of rehydration fluid per graft.
  • Submerge completely and soak until the tissue is fully rehydrated (thicker grafts may take up to 40 minutes).

    Tip:     Keep AlloDerm fully submerged by weighing it down, e.g. with sterile forceps.

    When AlloDerm is fully rehydrated, it is soft and pliable throughout. At this stage, it is ready for application to the surgical site. AlloDerm may be aseptically trimmed to required dimensions.
  • Important: use AlloDerm within 4 hours of rehydration.
Considerations:
  • If you are having a problem with rehydration, (with a sterile gloved hand), gently wipe/rub both sides of AlloDerm to remove any excess cryo-protectant that may be creating a barrier between the AlloDerm and the saline.
  • If not completely rehydrated, AlloDerm will appear to be of uneven thickness and have a mottled appearance.
  • Animal studies have shown that implanting dry AlloDerm induces a mild inflammatory response.
  • Antibiotics may be added to the second rehydration solution.
To Dertermine Orientation of AlloDerm for an Implantation Procedure

AlloDerm has two distinct sides: The basement membrane
and the dermal surface.

In an implant procedure, the dermal side should rest against the most vascular tissue to speed up the revascularization process.

How to Distinguish Sides

  • Physical appearance
    • Basement membrane side: Rough and dull.
    • Dermal side: smooth and shiny.
  • Distinguishing sides using the blood test
    • Add a drop of blood to both sides and rinse with rehydration solution. Since blood readily infiltrates the vascular channels within the matrix, the dermal side will look bright red. The basement membrane side will look pink.
AlloDerm handling properties and sizes

  • AlloDerm has the natural elasticity of human skin.
  • In order to establish the shape and dimension required for the graft, AlloDerm should be expanded intra-operatively.
  • When used for hernia repair, AlloDerm should be sutured intraoperatively under significant tension after proper rehydration; based on surgeons' experience, removing the laxity of AlloDerm will expand the surface area coverage of each piece used by up to 50%.
    • For example, a 16 x 20 cm piece of AlloDerm may expand to 19 x 25 cm after complete rehydration and when significant tension is applied intraoperatively.
  • The expected expansion of each graft should be considered when determining the size and number of grafts. Thicker graft sizes (those designated “X-Thick”/2.06 - 3.30 mm) will expand less than the “Thick” grafts (0.79 - 2.03 mm).
  • AlloDerm is available in a variety of sizes and thicknesses, enabling surgeons to choose the proper product for each procedure. (Most abdominal wall repairs—especially the more complex procedures—tend to require the larger pieces of AlloDerm.)
These sizes are the most common dimensions for abdominal wall reconstruction:



Product CodeNominal SizeAlloDerm w/ 50% ExpansionSurface Area CoverageThickness**
10232016 x 20 cm19 x 25 cm475 cm2Thick
98232016 x 20 cm19 x 25 cm475 cm2X-Thick
10214412 x 12 cm14.25 x 15 cm214 cm2Thick
98214412 x 12 cm14.25 x 15 cm214 cm2X-Thick
1021288 x 16 cm10 x 19 cm190 cm2Thick
9821288 x 16 cm10 x 19 cm190 cm2X-Thick
1021966 x 16 cm7.5 x 19 cm143 cm2Thick
9821966 x 16 cm7.5 x 19 cm143 cm2X-Thick
1020824 x 16 cm5 x 19 cm95 cm2Thick
9820804 x 16 cm5 x 19 cm95 cm2X-Thick
1020968 x 12 cm10 x 14 cm140 cm2Thick
9820968 x 12 cm10 x 14 cm140 cm2X-Thick
1020726 x 12 cm7.5 x 14 cm105 cm2Thick
9820706 x 12 cm7.5 x 14 cm105 cm2X-Thick
1020625 x 10 cm6 x 12.5 cm75 cm2Thick
9820605 x 10 cm6 x 12.5 cm75 cm2X-Thick
1020504 x 12 cm5 x 14 cm70 cm2Thick
9820484 x 12 cm5 x 14 cm70 cm2X-Thick

**Thick: 0.79 - 2.03 mm (0.031 - 0.080 inches)
**X-Thick: 2.06 - 3.30 mm (0.081 - 0.130 inches)

Your LifeCell representative can help with the correct selection.

For more information, contact LifeCell at 800-367-5737.

Preparing to Implant AlloDerm
  • Tissue can be shaped with scissors or scalpel and rolled or folded
    to necessary thickness.
  • When tissue is ready, store in the second saline wash until surgical site is prepared.
  • Important: Use AlloDerm within 4 hours of rehydration.


To Prepare the Surgical Site for AlloDerm Implantation
  • AlloDerm can be applied to open surgical sites allowing primary closure over the top of the tissue.
  • When replacing an integumental membrane, orient AlloDerm with the basement membrane side toward the cavity.
  • If primary closure is not possible, orient AlloDerm with the
    dermal side toward the most vascular surface and the basement membrane side exposed.
  • If AlloDerm is covering an avascular bed, orient the dermal side
    against vascularized flaps or tissues.
Plane of Placement

AlloDerm can be used as an underlay or an onlay. AlloDerm is useful in challenging patients with a range of co-morbid conditions that may increase the risk of complications if a synthetic material is used (e.g., obese, smoker, diabetic, malnutrition, etc.). In addition, AlloDerm is increasingly being used in challenging hernia repair—particularly in those cases where infection, hernia recurrence, and significant loss of abdominal fascia have traditionally made the surgeon’s job especially difficult.

Suturing AlloDerm

  • Nonabsorbable 2-0 suture (e.g., Prolene) is recommended
  • Use either a running or interrupted stitch, according to preference
  • When used for hernia repair, AlloDerm should be sutured under significant tension after complete rehydration.
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