Urinary Bladder Matrix in Complicated Open Wounds
Urinary Bladder Matrix in Complicated Open Wounds
A 3-year old male sustained a second-degree oil burn to his dorsal forearm that measured 8 cm x 4 cm. The middle part of the wound, measuring 3 cm x 2 cm, had a deeper burn and did not heal with conventional wound care. The patient underwent weekly applications of UBM and complete epithelialization of his wound was achieved in 3 weeks.
During a fire, a 52-year-old male sustained massive second and third degree burns to his right knee and lower leg that healed with local wound care and skin grafting. Eight years later, the patient sustained trauma to his right knee while walking up stairs and developed a chronic nonhealing ulcer at the initial burn site. He presented to the authors' office with a nonhealing open wound, measuring 5 cm x 3 cm, over his tibial tuberosity. Biopsy of the wound revealed chronic inflammation with no presence of Marjolin's ulcer. The ulcer was surrounded by diffuse scar tissue that precluded local reconstructive options. Conventional wound care and multiple skin grafting procedures were unsuccessful. The patient underwent weekly UBM application and his wound healed in 28 weeks.
A 61-year-old female sustained a severe crushing injury to her right knee. The wound was debrided at another institution. Upon debridement, patella was removed. As a result, the patient developed a large open wound of the anterior knee with exposed knee joint. In that same institution, a gastrocnemius muscle transfer and rectus abdominus muscle free flap reconstruction were attempted and both failed. Postoperatively, vacuum-assisted closure therapy alone was attempted and was also unsuccessful. Additionally, the patient developed occlusion of her superficial femoral artery and acute deep venous thrombosis, which precluded further reconstructive surgeries. The patient was informed she might need an above-the-knee amputation (Figure 1a) and was referred to the authors' institution for consultation and further management. The patient's wound, which measured 12 cm x 10 cm and had the knee joint exposed, was managed by application of UBM. Initially, UBM was used in combination with vacuum-assisted closure therapy. At 16 weeks, that therapy was discontinued and UBM application was continued on a weekly basis (Figure 1b). At 24 weeks, the wound completely closed and epithelialized, the extremity was salvaged, and the patient began physical therapy (Figure 1c).
(Enlarge Image)
Figure 1a.
A 61-year-old woman sustained a crushing injury to her knee. Following debridement at another institution, the patient developed a large open wound of the anterior knee with exposed knee joint This image shows the patient's open knee wound after failed gastrocnemius and rectus abdominis flaps.
(Enlarge Image)
Figure 1b.
After 16 weeks, vacuum-assisted closure therapy was discontinued and urinary bladder matrix applied weekly.
(Enlarge Image)
Figure 1c.
At 24 weeks, the wound was completely closed and epithelialized, the extremity was salvaged, and the patient began physical therapy.
A 54-year-old female underwent left breast mastectomy and immediate reconstruction with a pedicle transverse rectus abdominus muscle flap. Postoperatively, the patient developed partial flap necrosis, most probably secondary, to a previous transumbilical tubal ligation surgery. After debridement, the patient's open wound, which measured 6 cm x 4 cm, was managed with UBM and vacuum-assisted closure therapy (Figure 2a). Vacuum-assisted closure therapy was discontinued at 6 weeks (Figure 2b). Urinary bladder matrix therapy continued to be applied weekly, and the wound completely healed at 12 weeks (Figure 2c).
(Enlarge Image)
Figure 2a.
A 54-year-old female underwent left breast mastectomy and immediate reconstruction with a pedicle transverse rectus abdominus muscle flap. Postoperatively, the patient developed partial flap necrosis. This image shows the partial flap necrosis after transverse rectus abdominis myocutaneous breast reconstruction.
(Enlarge Image)
Figure 2b.
Vacuum-assisted closure therapy was discontinued at 6 weeks and urinary bladder matrix applied weekly.
(Enlarge Image)
Figure 2c.
The wound was completely closed at 12 weeks.
A 36-year-old female sustained severe crushing and degloving injuries to both hands resulting in large complicated open wounds. Specifically, the patient's left hand had a wound 8 cm in length that had 2 metacarpal bones completely exposed and devoid of periosteum. All extensor tendons were destroyed. The patient was not a good candidate for a free flap reconstruction due to the extent of the injury (Figure 3a). Serial debridement and subsequent skin grafting were planned. The part of the wound with exposed bones was managed with serial application of UBM in an effort to provide scaffold for skin graft take. One month after initial injury, the 8 cm degloving hand wound with exposed metacarpals was successfully covered with newly formed soft tissue (Figure 3b). The wound underwent minimal contraction, and this allowed successful application of a 6 cm skin graft 9 weeks after the initial injury. After a course of rehabilitation therapy the patient achieved satisfactory functional recovery relative to the severity of the injury (Figure 3c).
(Enlarge Image)
Figure 3a.
A 36-year-old female sustained severe crushing and degloving injuries to both hands resulting in large complicated open wounds with 2 exposed metacarpal bones and extensor tendons.
(Enlarge Image)
Figure 3b.
In 4 weeks, complete coverage of the exposed bones with newly formed soft tissue was achieved.
(Enlarge Image)
Figure 3c.
The patient achieved full coverage of wound with skin graft and satisfactory functional thumb abduction, extension, and flexion.
Results
Case 1
A 3-year old male sustained a second-degree oil burn to his dorsal forearm that measured 8 cm x 4 cm. The middle part of the wound, measuring 3 cm x 2 cm, had a deeper burn and did not heal with conventional wound care. The patient underwent weekly applications of UBM and complete epithelialization of his wound was achieved in 3 weeks.
Case 2
During a fire, a 52-year-old male sustained massive second and third degree burns to his right knee and lower leg that healed with local wound care and skin grafting. Eight years later, the patient sustained trauma to his right knee while walking up stairs and developed a chronic nonhealing ulcer at the initial burn site. He presented to the authors' office with a nonhealing open wound, measuring 5 cm x 3 cm, over his tibial tuberosity. Biopsy of the wound revealed chronic inflammation with no presence of Marjolin's ulcer. The ulcer was surrounded by diffuse scar tissue that precluded local reconstructive options. Conventional wound care and multiple skin grafting procedures were unsuccessful. The patient underwent weekly UBM application and his wound healed in 28 weeks.
Case 3
A 61-year-old female sustained a severe crushing injury to her right knee. The wound was debrided at another institution. Upon debridement, patella was removed. As a result, the patient developed a large open wound of the anterior knee with exposed knee joint. In that same institution, a gastrocnemius muscle transfer and rectus abdominus muscle free flap reconstruction were attempted and both failed. Postoperatively, vacuum-assisted closure therapy alone was attempted and was also unsuccessful. Additionally, the patient developed occlusion of her superficial femoral artery and acute deep venous thrombosis, which precluded further reconstructive surgeries. The patient was informed she might need an above-the-knee amputation (Figure 1a) and was referred to the authors' institution for consultation and further management. The patient's wound, which measured 12 cm x 10 cm and had the knee joint exposed, was managed by application of UBM. Initially, UBM was used in combination with vacuum-assisted closure therapy. At 16 weeks, that therapy was discontinued and UBM application was continued on a weekly basis (Figure 1b). At 24 weeks, the wound completely closed and epithelialized, the extremity was salvaged, and the patient began physical therapy (Figure 1c).
(Enlarge Image)
Figure 1a.
A 61-year-old woman sustained a crushing injury to her knee. Following debridement at another institution, the patient developed a large open wound of the anterior knee with exposed knee joint This image shows the patient's open knee wound after failed gastrocnemius and rectus abdominis flaps.
(Enlarge Image)
Figure 1b.
After 16 weeks, vacuum-assisted closure therapy was discontinued and urinary bladder matrix applied weekly.
(Enlarge Image)
Figure 1c.
At 24 weeks, the wound was completely closed and epithelialized, the extremity was salvaged, and the patient began physical therapy.
Case 4
A 54-year-old female underwent left breast mastectomy and immediate reconstruction with a pedicle transverse rectus abdominus muscle flap. Postoperatively, the patient developed partial flap necrosis, most probably secondary, to a previous transumbilical tubal ligation surgery. After debridement, the patient's open wound, which measured 6 cm x 4 cm, was managed with UBM and vacuum-assisted closure therapy (Figure 2a). Vacuum-assisted closure therapy was discontinued at 6 weeks (Figure 2b). Urinary bladder matrix therapy continued to be applied weekly, and the wound completely healed at 12 weeks (Figure 2c).
(Enlarge Image)
Figure 2a.
A 54-year-old female underwent left breast mastectomy and immediate reconstruction with a pedicle transverse rectus abdominus muscle flap. Postoperatively, the patient developed partial flap necrosis. This image shows the partial flap necrosis after transverse rectus abdominis myocutaneous breast reconstruction.
(Enlarge Image)
Figure 2b.
Vacuum-assisted closure therapy was discontinued at 6 weeks and urinary bladder matrix applied weekly.
(Enlarge Image)
Figure 2c.
The wound was completely closed at 12 weeks.
Case 5
A 36-year-old female sustained severe crushing and degloving injuries to both hands resulting in large complicated open wounds. Specifically, the patient's left hand had a wound 8 cm in length that had 2 metacarpal bones completely exposed and devoid of periosteum. All extensor tendons were destroyed. The patient was not a good candidate for a free flap reconstruction due to the extent of the injury (Figure 3a). Serial debridement and subsequent skin grafting were planned. The part of the wound with exposed bones was managed with serial application of UBM in an effort to provide scaffold for skin graft take. One month after initial injury, the 8 cm degloving hand wound with exposed metacarpals was successfully covered with newly formed soft tissue (Figure 3b). The wound underwent minimal contraction, and this allowed successful application of a 6 cm skin graft 9 weeks after the initial injury. After a course of rehabilitation therapy the patient achieved satisfactory functional recovery relative to the severity of the injury (Figure 3c).
(Enlarge Image)
Figure 3a.
A 36-year-old female sustained severe crushing and degloving injuries to both hands resulting in large complicated open wounds with 2 exposed metacarpal bones and extensor tendons.
(Enlarge Image)
Figure 3b.
In 4 weeks, complete coverage of the exposed bones with newly formed soft tissue was achieved.
(Enlarge Image)
Figure 3c.
The patient achieved full coverage of wound with skin graft and satisfactory functional thumb abduction, extension, and flexion.
Source...