Mechanical and clinical performance of acellular allogeneic dermis combined with autologous split-thickness skin grafts for ankle soft tissue defect repair.

Abstract

To evaluate the clinical efficacy, wound healing quality, and functional recovery of a composite grafting technique using acellular dermal matrix (ADM) and autologous split-thickness skin graft (ASTSG) for reconstructing complex ankle soft tissue defects. A retrospective cohort study included 108 patients with ankle soft tissue defects (≥3 cm²). Patients were divided into an observation group (n = 55, ADM+ASTSG) and a control group (n = 53, pedicled skin flap). Primary outcomes were graft survival, wound healing time, and scar quality (Vancouver Scar Scale). Secondary outcomes included ankle function (range of motion, gait analysis), operative parameters, cost, and histological assessment of neotissue. The ADM+ASTSG group demonstrated a significantly higher graft survival rate (96.80 % vs. 78.22 %, P < 0.05) and superior scar quality at 6 months (VSS total score: 2.3 ± 0.8 vs. 4.7 ± 1.1, P < 0.05). Functional recovery was better, evidenced by greater ankle range of motion and gait symmetry (68.3 ± 5.2 % vs. 59.6 ± 4.8 %, P < 0.05). The technique also resulted in shorter operative time (36.6 ± 6.3 vs. 118.6 ± 11.4 min, P < 0.05) and lower hospitalization costs. Histologically, the ADM group showed more organized collagen fibers and a higher collagen I/III ratio, indicating more mature tissue regeneration. The ADM+ASTSG composite grafting technique promotes high-quality wound healing and functional recovery in ankle soft tissue defects, offering a clinically effective and cost-efficient alternative to traditional flaps. Its ability to support structured tissue regeneration translates into superior scar quality and mechanical adaptability for the dynamic ankle joint.