Road Rash in the Pediatric Patient: the Advantages of Mono- and Bilayer Bovine Collagen Glycosaminoglycan Matrices

Purpose: We present a case of extensive lower extremity road rash and a distal fibular fracture in a 13-year-old female secondary to a golf cart injury.  

Methods: The dermal injuries involved her lateral thigh, anterior knee, the medial and lateral lower leg with the deepest trauma occurring at the medial ankle with exposed periosteum. Irritation and debridement of the nonviable tissue and debris was emergently performed. The distal fibula fracture was minimally displaced and thus treated conservatively.  Two days later the patient was taken back to the operating room for repeat debridement and application of the bovine collagen-glycosaminoglycan tissue matrixes to cover the extensive wounds. The thin monolayer tissue was placed over the majority of the road rash and the bilayer was placed over the medial malleolus wound with exposed periosteum.

Results: The tissue matrices significantly reduced the inflammation, drainage, and pain that normally accompanies road rash injury. The monolayer helped to heal the majority of the wounds within 6 weeks from injury and without painful dressing changes. Following the removal of the silicone sheet from the bilayer graft, the deeper medial malleolus ulceration continued to heal with applications of Leptospermum honey calcium alginate dressings. With accelerated healing of the skin, we were able to begin protected ambulation in a CAM boot at 7 weeks post-injury.

Conclusions: This case illustrates the advantages of using mono-and bilayer bovine collagen tissue matrices for varying depth wounds associated with road rash.  We found overall decreased inflammation and drainage of the wounds which we believe correlated to the patient's decreased pain and trauma during the frequent dressing changes.