Reconstruction of Complex, Chronic Pressure Ulcers and Wounds with Osteomyelitis - Skin Substitutes, Really?

Background:
The use of skin substitutes for the treatment of chronic wounds is common today. There are a variety of tissues types available, including both human- and animal- based tissues most commonly used for treating chronic venous and diabetic wounds. Given the breadth of possible uses, can these tissue types be used in reconstruction of more complex and chronic wounds? This hypothesis was tested in two patients. Acellular dermal tissue matrix derived from fetal bovine dermis (AFBDM)* was used to reconstruct a complex limb salvage case and a chronic, stage 4 pressure ulcer. Dermal tissue matrix has demonstrated assimilation and the promotion of vascularized tissue.

Methods:
Case 1 was an elderly patient with a chronic sacral pressure ulcer and exposed sacral bone, and case 2 was a 37-year-old patient with diabetes and end stage renal disease coupled with severe peripheral vascular disease, who had exposed, infected bone on her left foot transmetatarsal amputation wound which had dehisced. Both cases were reconstructed using an AFDBM. Fenestrated grafts were placed after sharp surgical debridement of the wounds. The grafts were then covered with standard moist wound therapy dressings.

Results:
For case 1, the sacral pressure ulcer with exposed sacral bone had robust tissue coverage with contracture of the wound. This allowed for final closure with a split thickness skin graft. For case 2, the limb salvage patient was treated in multiple stages by layering AFDBM over exposed hardware and soft tissue. Over the course of treatment, the osteomyelitic bone was able to be not only covered but reepithelization of the tissue occurred as well.

Conclusions:
In patients with comorbidities known to delay healing, the use of an AFDBM promoted the healing and, ultimately, reconstruction of complex wounds with complications of vascular compromise and exposed bone or tendon.

Trademarked Items (if applicable): PriMatrix®, Integra LifeSciences Corp., Princeton, NJ

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