Ovine Forestomach Matrix Is Efficacious in Complex Soft Tissue Non-healing Defects

Abstract Body: Biomaterial technologies for the closure of soft tissue defects have a well-established niche in the armamentarium of the providers. Success has been noted using extracellular matrix biomaterials to promote tissue regeneration.  One such product is ovine forestomach matrix (OFM) graft*, recently introduced for the repair of complex soft tissue defects.  OFM includes remnants of the basement membrane, lamina propria, and submucosa.  It is rich in collagen I, III, IV, elastin, and adhesive proteins, fibronectin and laminin.  OFM is postulated to promote tissue regeneration via several mechanisms.  It acts as a biomimetic that stimulates cellular activation and migration to the defect using retained growth factors. OFM acts as a scaffold for fibroblast cells, resulting in connective tissue deposition.  An in vivo study has demonstrated that the connective tissue is deposited in an organized fashion and results in acceptable tensile strength, biomaterial incorporation, all without an excessive inflammatory response. Robust angiogenesis, demonstrated in both in vivo and in vitro experimentation, is promoted by growth factors within OFM to support tissue deposition. A product with these characteristics may be particularly efficacious when used to heal surgical complications.  A classic tenet of surgery states, “dissect only along named structures.”  From a histological perspective, this refers to the fact that it is preferable to expose structures by dissecting through the loose, mostly avascular, and easy-to-separate areolar tissue between fascial planes to minimize tissue trauma. This tissue manipulation does induce an inflammatory reaction that disrupts the normal function and interaction of adjacent tissue layers. This in turn results in potential “dead space” between the tissue planes and increased risk of post-operative complications.  This includes delayed wound healing, site infection, seroma, return to OR and chronic non-healing. OFM attempts to recreate the normal functional relationship of the disrupted tissue layers as described.  This promotes soft tissue repair, and prevention of larger tissue loss.  We present a case series demonstrating successful return to organized healing of chronic non-healing defects that were resistant to standard-of-care treatment.  Our study adds to the growing body of evidence that OFM is a safe and efficacious choice of biomaterial for surgical management.