Morselized Ovine Forestomach Matrix (OFM) for Treatment of Degloving Injury: A Case Study in Innovative Treatment of Complex Wounds

Introduction: Degloving injuries are traumatic events in which the skin and tissue are torn away from underlying structures. These injuries present complex challenges requiring prompt surgical intervention and innovative wound care strategies to ensure optimal recovery and minimize complications. This case report investigates the use of morselized ovine forestomach matrix (OFM) in the reconstruction of a severely injured right lower limb following a traumatic degloving injury. The aim was to explore the use of morselized OFM to support coverage of severely damaged tissue at high risk of necrosis, accelerate the healing process, and decrease time interval between injury and skin grafting.Methods:A 78-year-old patient with a high functional status presented with extensive injuries to the right lower leg following a pedestrian-vs-automobile collision. The patient suffered a proximal fibular fracture as well as severe degloving injuries. The avulsed soft tissue was significantly damaged, with some areas deemed unsuitable for immediate skin grafting due to extensive tissue necrosis and venous congestion. Initial sharp debridement was performed to address the necrotic tissue, and Myriad Morcells* were applied to promote rapid granulation. Given the complexity of the injury, a negative pressure wound therapy (NPWT) dressing was employed to enhance tissue salvage and support healing. Adequate granulation was achieved five weeks after Morcells application, at which point a split-thickness skin graft was placed over the anterior lower leg and posterior calf.Results:Follow-up assessments revealed a decrease in wound exudate and signs of infection, indicating a positive response to the treatment regimen. Reevaluation of the patient post-op day 13 showed satisfactory granulation of the wound bed, with notable improvement and reduced risk of scar contracture. Imaging confirmed adequate blood flow. Ambulation was well preserved.Discussion: This case emphasizes the success of skin grafting in degloving injuries achieved by employing morselized OFM in conjunction with surgical interventions and wound care. The utilization of morselized OFM facilitated proper granulation allowing for skin grafting. This case emphasized the potential of morselized OFM as a promising tool in complex degloving cases, offering insights into innovative approaches preserving mobility and function in severe lower extremity trauma cases.References:1. Xu Q, Zhu L, Wang G, Sun Y, Wang J, Lin J, Pei Y, Cui Y, Liu B, Yuan X, Zhang H, Zang C. Application of cryopreserved autologous skin replantation in the treatment of degloving injury of limbs. J Plast Reconstr Aesthet Surg. 2022 Jul;75(7):2387-2440. doi: 10.1016/j.bjps.2022.04.006. Epub 2022 Apr 21. PMID: 35508521. 2. Son JH, Bafus B, Khandelwal A, Chepla KJ. Reconstruction of a Circumferential Upper Extremity Soft Tissue Defect With a Dermal Regeneration Template and Skin Grafting. Tech Hand Up Extrem Surg. 2018 Mar;22(1):31-33. doi: 10.1097/BTH.0000000000000185. PMID: 29360674. 3. Andres T, von Lübken F, Friemert B, Achatz G. Vacuum-Assisted Closure in the Management of Degloving Soft Tissue Injury: A Case Report. J Foot Ankle Surg. 2016 Jul-Aug;55(4):852-6. doi: 10.1053/j.jfas.2015.12.002. Epub 2016 Jan 27. PMID: 26826925. 4. Yan H, Gao W, Li Z, Wang C, Liu S, Zhang F, Fan C. The management of degloving injury of lower extremities: technical refinement and classification. J Trauma Acute Care Surg. 2013 Feb;74(2):604-10. doi: 10.1097/TA.0b013e31827d5e00. PMID: 23354258.