(CS-048) A case report on the use of a novel polylactic acid dermal matrix for achieving wound healing of a 25-year-old pyoderma gangrenosum ulcer

Pyoderma gangrenosum (PG) is characterized by hard-to-heal wounds refractive to treatment. Here, we present our experience using a novel polylactic acid (PLA) closure matrix to promote the healing of a 25-year-old PG ulcer.

Methods:

Bi-weekly applications of PLA matrices were performed on this patient until healing.

Results:

The case consists of a 72-year-old male with bilateral leg venous insufficiency, atrial fibrillation under anticoagulation and a story of pyoderma gangrenosum ulcers. The patient had been followed up for wound care by the same physician for the past 25 years. Despite multiple attempts with the use of immunomodulatory therapies, CTPs, and other advanced wound treatments, an ulcer on the left leg had been persistently open during all the follow-up time. The wound had periods of relative improvement, stabilization, and flare-ups that led to tissue breakdown and increased ulcer size. Therefore, any treatment was considered palliative and only to help improve the patient’s quality of life. In 2023, a novel PLA closure matrix was launched into the market. This product contains 75% lactide, which exerts immunomodulatory effects on the wound bed, so we decided to try it on the patient to control the inflammation and promote healing. Surprisingly, within 2 weeks, the wound shifted from a fibrotic and sloughy bed into a granular one. Additionally, the erythematous peri-wound areas reduced in size, and epithelial borders started growing. Four weeks later, the wound size had reduced by over 50%, even achieving bridges of fully healed skin. Within 8 weeks, the wound had closed more than 90%, and the repair tissue looked almost identical to non-injured skin, without any contracture or major scarring. Ten weeks later, the wound was fully healed and has remained closed for the past 2 months.

Discussion:

This remarkable case exemplifies the powerful effects of a next-generation synthetic CTP that leverages lactide and its lactate monomer to achieve wound healing. These effects can be summarized as anti-inflammatory, pro-angiogenic, anabolic, and pH-stabilizing. In the context of PG, this helps stabilize the wound’s environment, lower the inflammatory environment, enhance the neo-vascularization and ECM production of the wound bed, and promote ulcer healing.