Abstract and Introduction
Abstract
Introduction: Flap reconstruction of pressure ulcers offers an important clinical means of decreasing morbidity in hospitalized patients. A new, novel method of managing pressure ulcer wounds uses a synthetic hybrid-scale fiber matrix prior to tissue flap reconstruction. This synthetic hybrid-scale fiber matrix is comprised of micron-scale and nanoscale fiber structure similar to that of human extracellular matrix and supports cell ingrowth, retention, and granulation tissue formation.
Objective: The primary objective of the present study was to examine use of the synthetic hybrid-scale fiber matrix as a means of encouraging granulation tissue within complex wounds to promote successful and lasting wound closure following flap reconstruction.
Materials and Methods: Patients included in this retrospective study had pressure ulcers that were not successfully managed with other wound therapies; in addition, these patients presented with various risk factors for postoperative complications. Before treatment, sharp debridement of the wound margins and wound bed was performed. Wounds were subsequently treated by applying synthetic hybrid-scale fiber matrix prior to flap reconstruction, based on physician assessment of wound status. The primary objective to include the synthetic hybrid-scale fiber matrix in the treatment approach of pressure ulcers in this case series was to ensure (1) integration to the wound bed prior to flap closure to encourage granulation tissue formation at a later time and (2) lasting successful wound closure following flap reconstruction.
Results: Overall, the patient outcomes indicated that the synthetic hybrid-scale fiber matrix was used to manage pressure ulcers successfully, with a wound closure rate of 90.9% (10 cases of complete wound closure and 1 case of 97.2% wound area reduction). Additionally, no complication related to the application of each synthetic hybrid-scale fiber matrix was reported.
Conclusions: Application of synthetic hybrid-scale fiber matrix to the wound bed prior to flap closure promotes cellular ingrowth and granulation tissue formation, which promotes successful and lasting wound closure following flap reconstruction.
Introduction
Flap reconstruction of pressure ulcers offers an important clinical means of decreasing morbidity in both inpatient and outpatient settings. Unfortunately, complication rates following pressure ulcer reconstruction using flap coverage are reportedly high, as patients commonly have multiple risk factors for postoperative dehiscence, hematoma formation, partial or complete flap necrosis, infection, and ulcer recurrence.[1–3] Risk of pressure ulceration in patients with spinal cord injury, the elderly population, and patients who are immobilized due to chronic conditions is significant.[4] On average, the prevalence of pressure ulcer in patients across various care settings in the United States was reportedly 9%.[4,5] A novel method of managing chronic wounds was developed in which a synthetic hybrid-scale fiber matrix is applied prior to flap reconstruction. A retrospective study reported complete wound closure rates of 85% in diabetic foot ulcers and 91% in venous leg ulcers after 12 weeks when the synthetic hybrid-scale fiber matrix was included in the clinical approach.[6]
The structure of Restrata Wound Matrix (Acera Surgical, Inc) is similar to that of human extracellular matrix (ECM) and supports cell ingrowth, retention, and granulation tissue formation.[7] This synthetic hybrid-scale fiber matrix is the only flexible, suturable, electrospun matrix for use in encouraging wound healing. The matrix is fabricated by solvent electrospinning polyglactin 910 poly (lactic-co-glycolic acid) (10:90) and polydioxanone, polymers approved by the US Food and Drug Administration, and it has been used in biomedical devices such as resorbable polymers.[7] The synthetic hybrid-scale fiber matrix was analyzed per International Organization for Standardization-10993 standards, and results confirmed the safety and biocompatibility of the matrix.[8] The matrix resorbs in 1 to 4 weeks depending on the wound condition and type.[7,9] The degradation products of the synthetic matrix are safe and can be cleared without the risk of biofilm formation.[7] The matrix is composed of nonwoven, resorbable, synthetic hybrid-scale fibers with a structure and architecture that mimics that of native human ECM. Due to its unique design, the matrix resists enzymatic degradation, persists in the wound bed, has excellent biocompatibility, and supports cellular and/or tissue ingrowth. The unique properties of the synthetic hybrid-scale fiber matrix also offer ease of use, availability for use in both the inpatient and outpatient settings, and clinical versatility with significant logistical advantages over existing amniotic, allogenic, and biologic products.
Electrospun hybrid-scale fibers support cellular ingrowth, retention, and differentiation while directing and enhancing cellular activity. The porosity and progressive resorption of the matrix support continued cellular infiltration, tissue formation, and neovascularization. Prior studies confirmed that the synthetic materials are a unique alternative to allografts and xenografts in supporting wound healing.[7] The primary objective to include the synthetic hybrid-scale fiber matrix in the treatment approach of pressure ulcers in this case series was to ensure (1) integration to the wound bed prior to flap closure to encourage granulation tissue formation at a later time, and (2) lasting successful wound closure following flap reconstruction.