Case Series/Study

(CS-020) Full Thickness Wound Reconstruction After Wide Excision of Recurrent Plantar Fibromatosis

Co-Author(s):

Introduction: <span style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; color: black; background: white; mso-ansi-language: EN-US;">Plantar fibromatosis (PF) is a rare hyperproliferative benign lesion of the plantar aponeurosis with an unknown cause. Traditionally PF is managed with conservative care including, offloading, corticosteroid injections, and anti-inflammatory drugs. When conservative treatment fails, surgical options are offered. Local surgical excision of these lesions has a high recurrence rate (60-100%) with wide excision resection associated with less recurrence rate <span style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; color: black; background: white; mso-ansi-language: EN-US;">(van der Veer et al. 2008)<span style="mso-ascii-font-family: Calibri; mso-ascii-theme-font: minor-latin; mso-hansi-font-family: Calibri; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; color: black; background: white; mso-ansi-language: EN-US;">. When the fibroma involves the subcutaneous tissue, this is often resected, and primary closure is not an option. Here we present the use of an ovine foresomtach matrix (OFM) graft in soft tissue reconstruction. Methods: <span style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-theme-font: minor-latin; color: black; background: white; mso-ansi-language: EN-US; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;">60<span lang="EN-NZ" style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-ansi-language: EN-NZ; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;">-year-old male with history of recurrent plantar fibromatosis who had 3 previous surgical excisions underwent a wide excision (2 cm margins) of the recurrent lesions leaving a resulting wound bed roughly 15 cm x 8 cm x 1.5 cm. There was an 8 cm segment of exposed flexor tendon and also exposed periosteum of the 1st MTP joint. <span lang="EN-NZ" style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-ansi-language: EN-NZ; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;">The OFM graft<span style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-ansi-language: EN-US; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;">^ <span lang="EN-NZ" style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-ansi-language: EN-NZ; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;">was fixed directly into the defect for immediate coverage and subsequently temporized the defect via granulation tissue formation. The defect granulation and epithelialization was monitored until closure was achieved and the final aesthetic and functional outcome was also evaluated. Results: <span lang="EN-NZ" style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-ansi-language: EN-NZ; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;">The patient was able to achieved coverage of the exposed vital structures with viable neodermis by 10 days post-application. From there, twice weekly applications of OFM single layer+ was performed bedside to achieve further robust granular neodermis over the MTP joint for and four weeks. This resulted in robust coverage of this surface and the formation of adequate neodermis to allow for split-thickness skin graft (STSG) to be applied. Primary endpoints were time to 100% granulation of exposed vital structures and time to STSG application. Secondary endpoints were time to 100% STSG take and skin cosmesis and functional tissue remodeling<span style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-ansi-language: EN-US; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;">. Discussion: <span lang="EN-NZ" style="font-size: 11.0pt; font-family: 'Calibri',sans-serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-ansi-language: EN-NZ; mso-fareast-language: EN-GB; mso-bidi-language: AR-SA;">The present case report highlights the use of an extracellular matrix graft and single layer graft, both derived from ovine forestomach in the successful reconstruction of a full thickness wound secondary to plantar fibromatosis wide excision. While such dermal matrices do not supersede or replace flap procedures, they represent an alternative option on the reconstructive ladder in cases where flap procedures are not appropriate or possible. Surgical management of plantar fibromatosis can lead to high recurrence rates and other complications. Utilizing OFM in the surgical algorithm can provide immediate coverage of exposed vital structures and shorten time to definitive closure. Trademarked Items: ^ Myriad Matrix, Aroa Biosurgery Limited, New Zealand
+ Endoform Natural, Aroa Biosurgery Limited, New Zealand References: van der Veer, W. M., S. M. Hamburg, A. de Gast, and F. B. Niessen. 2008. 'Recurrence of plantar fibromatosis after plantar fasciectomy: single-center long-term results', Plast Reconstr Surg, 122: 486-91.