(CS-122) Using a polylactic acid dermal matrices over wound avascular structures

Wounds with avascular components are a challenge in wound care, as they lack blood flow and the potential to heal. Typical structures include tendon, bone without periosteum, joint surface, and osteosynthesis hardware. Here, we present a case series of patients treated with a novel poly-lactic acid (PLA) dermal matrix to promote wound repair over avascular structures.

Methods:

Bi-weekly applications of PLA matrices until healing.

Results:

Patient 1 is a 57-year-old female with uncontrolled diabetes and lupus. Following a fall, she presented an ulcer on a leg with exposed bone. The ulcer failed to heal , and due to intense pain and concerns over more tissue damage, she refused any surgical procedures. PLA matrices were used to cover the defect. Granulation tissue and epithelium grew from the wound’s edges, fully covering the defect within 5 weeks. Patient 2 consists of a 55-year-old male without comorbidities with an exposed tibial fracture and a subsequent surgical site infection. The wound was highly necrotic and sloughy, with exposed osteosynthesis material. PLA matrices were applied following abscess drainage and debridement. Within 4 weeks, granulation tissue covered the metal implants, and the wound completely healed without major scarring. Patient 3 is a 45-year-old male with a full-thickness contact burn in the nuchal area. After debridement, significant neck fascia was exposed. A PLA matrix was applied in the OR, leading to adequate coverage of the structures with granulation tissue within 2 weeks. The wound bed temporization allowed the patient to receive a skin graft that integrated 100%. Finally, patient 4 is a previously healthy 24-year-old male who had a motorcycle accident with an exposed tibial fracture. His leg was fixed with an intramedullary nail; however, due to bone and soft tissue loss, a large defect extending into the medullary canal was left behind. The wounds were treated with PLA matrices, and the defect was packed with the material. The defect was filled with granulation tissue two weeks later, and most superficial skin wounds had completely healed. By the third week, only the area surrounding the tissue defect remained open but filled with adequately vascularized granulation tissue that received a skin graft for definite closure.

Discussion:

PLA matrices are suitable for covering avascular wound components. They produce an intense neo-vascularization and granulation response that helps preserve tissue viability and integrity, leading to secondary closure or conditioning of the wound for definite repair with surgical techniques.