Preliminary Experience Using Axolotl (Ambystoma Mexicanum) Dermis Patches as a Biologic Agent for Wound Management After Neurosurgical Procedures

Introduction: In the United States, chronic wounds affect more than 6.5 million people annually, costing more than $25 billion, with a mean cost of $23,755 among neurosurgery patients. Current solutions for wound management have several disadvantages, including risks of rejection, disease transmission from mammalian-sourced materials (such as viruses or prions), and cultural issues prohibiting the use of some products. Here, we describe preliminary use of xenograft tissue derived from the dermis of neotenic salamanders (Ambystoma mexicanum - the axolotl) for clinical use in wound management after various neurosurgical procedures.Methods:A prospectively maintained database was retrospectively searched for consecutive patients who underwent wound closures using axolotl dermis patches (NeoMatriX, NeXtGen Biologics, Alachua, FL). Data collected included patients’ demographics, daily alcohol and tobacco use, radiation history, operation type, and antibiotic regimen post-closure. Rates of postoperative infection, wound dehiscence, and wound revision or repeated irrigation were collected for outcomes assessment.Results:29 patients (mean age 62.3 years) underwent wound closure with axolotl dermis patches. At least one relevant comorbidity related to delayed wound closure—diabetes mellitus=4(13.8%), obesity=7(24.1%), hypertension=8(27.6%), hyperlipidemia=9 (31.2%), cancer=4(13.8%), daily alcohol use=4(13.8%), and smoking=5(17.2%)—was present in all 29(100%) included patients. The wounds were from 5(17.2%) decompressive laminectomy, 6(20.7%) microdiscectomy, 3(10.3%) cranioplasties, 2(6.9%) craniotomies, 5(17.2%) thoracolumbar instrumentation revisions, 1(3.4%) pseudoaneurysm ligation and resection, 2(6.9%) aneurysm clippings, and 6(20.7%) microvascular decompression for trigeminal neuralgia. The patches were used for primary wound closure in 15(51.7%) patients and for secondary wound closure in 14(48.3%). There were 0 cases of postoperative wound infection, revision, dehiscence, or irrigation after closure with the patches. Minimal scarring was observed for all patients.Discussion: The use of pro-regenerative neotenic salamander material for mammalian wound management has favorable potential in improving neurosurgical wound closure and healing, preventing extended hospital stays and poor overall outcomes.References: