The use of polyurethane open cell foam and staged skin grafting for limb salvage in heavily contaminated wounds

Introduction: Massive extremity wounds occur at times that are very difficult to clean even in the operating room. Sometimes the patient's overall condition makes wide debridement difficult, at other times being adjacent to important structures such as tendons nerves and blood vessels makes further debridement inopportune. When such structures are exposed however a moisture retaining dressing, is necessary to help prevent desiccation and provide granulation. Options can include cadaveric skin and silicone backed dermal regenerative templates. A new open cellular polyurethane foam presents another option in this armamentarium.

Methods: We present a retrospective review of 12 patients, all of whom were very ill, who had exposed structures including tendon and nerve; which were debrided in the operating room with tangential hydro surgery and covered with open cellular polyurethane foam and negative pressure wound therapy followed by skin grafting.

Results: The median age of the patient's was 62, represented 8 women and 4 men. Four were white, 4 were black, and 4 were Latino. The median size of the wound was 420 sq cm. All 12 patients had greater than 85% granulation when the open cellular polyurethane foam was explanted. Explantation date was day 21 and skin graft date was day 28. One patient went on to receive a above knee amputation due to ongoing pain, despite excellent granulation full tissue coverage day 21. One patient did not go on to skin grafting for 2 months due to severe cardiac disease.

Conclusion: We have found the open cellular polyurethane foam to outperform our expectations. It is been very cost efficient product for massive extremity wounds that have been difficult to fully clean and require a moisture retaining dressing. In these large wounds it does seem to primarily act as a bridge to skin grafting. The mechanism of action by which it provides a good granular bed is not fully elucidated.