Successful Management of Tunneling Wounds with the use of Synthetic Self-Assembling Peptide Matrix

Introduction: Tunneling or sinus tracts are complex wounds that often present a challenge to healthcare practitioners. These can extend deep into the subcutaneous tissues or muscle in which due to the size and depth, makes wound management challenging and complicated. Unfortunately, sometimes these wounds do not respond to standard of care and using advanced wound therapy is an option to promote wound closure. One such therapy is utilizing a synthetic self-assembling peptide matrix (SAPM) to help initiate wound healing.Methods:This case series presents four  hard to heal wounds with tunneling. Two wounds were the result from surgical dehiscence, a post radiation injury and status post incision and drainage of abscess. The age of these chronic wounds ranges from 3 to 5 months and did not respond to standard of care and advanced wound therapy such as collagen, NPWT and cellular tissue-based products. The depth of the tunnel ranges from 3.1 cm to 6 cm. Wound treatment plan for these wounds were weekly assessment, including the use of real time fluorescence imaging to detect pathogenic bacteria and near infrared spectroscopy studies to evaluate microcirculation and oxygenation, debridement as needed, wound cleansing, and application of synthetic self-assembling peptide matrix.Results: The overall size and depth of all the wounds showed marked improvement post application of SAPM. The number of applications range from 2 to 4 cm.  Depth decreased from 0.5 cm to 1.7 cm. Post SAPM, wounds were treated with SOC and progressed to wound closure.Discussion: The use of SAPM in these cases demonstrated efficacy in the treatment of these previously stalled wounds. It helped re-initiate the wound healing cascade and progression to wound closure. SAPM  is made of proprietary peptide synthesized from naturally occurring amino acids. The synthetic peptide self-assembles upon application to the ionic wound bed forming a nanofiber network resembling an extracellular matrix to facilitate cell migration, tissue growth and repair. It can provide a physical barrier to help mitigate contamination and modulate inflammation. On application to wound bed, the consistency  of SAPM turns to semi-solid that contour to the irregular and uneven wound surface, making it easy to apply to these deep tunneling wounds. This wound treatment can be a viable option in the  management of  hard to heal, tunneling wounds.References: