(CS-129) Bilayer Wound Matrix in Challenging Situations and Compromised Patients to Obtain Coverage of Bone and Tendon

Co-Author(s):

Leta McCarty Messinger, BSN, RN, SWOC – , Assistant Director, Wound Program, Community Hospital, Monterey Peninsula; Philippe Taupin, PhD

Introduction:

Soft tissue defects in compromised patients present a significant challenge to the reconstructive surgeon, particularly when vital structures are exposed. Acellular dermal matrices are now widely used in reconstructive and plastic surgery and offer new opportunities for soft tissue coverage. We report 4 cases of adult patients with a variety of competing and challenging medical problems whose wounds were managed with Meshed Bilayer Wound Matrix (IMBWM).

Methods:

Patient 1, a heavy smoker with well-controlled HIV, had a significant degloving of the scalp down to the calvarium. Patient 2, with a giant neglected tumor of the posterior scalp, had a defect comprising the entire occipital skull down to the calvarium. Patient 3, with venous stasis, congestive heart failure and a necrotizing infection, had an open wound of the lower extremity. Patient 4, with neglected diabetes, non-compliance and necrotizing infection, had a right pretibial wound. All the wounds had exposed structures, and were managed using different modalities, including the serial application of dermal matrices.

Results:

In patients 1, 2, and 3, the wounds were allowed to close by secondary intention, whereas a STSG was settled in patient 4. The hairline was restored in patient 1. Wound closure ultimately occurred over the next 16 months after matrix placement in patient 3, with the size of the wound fluctuating as the patient’s heart failure waxed and waned. A second application of dermal matrix was performed on patients 2 (matrix take 75%) and 4 (matrix take 90%) to obtain full coverage of the wounds.

Discussion:

Each patient obtained stable soft tissue coverage and successful reconstruction, with satisfactory cosmesis and no functional issues. Results from these 4 cases highlight the capacity and capability of IMBWM to allow coverage of exposed bone and tendon, in a diverse set of cases with very compromised patients and a variety of competing medical problems. The benefits of the serial application of dermal matrices remains to be further studied and evaluated.

Trademarked Items: Integra Meshed Bilayer Wound Matrix

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