(CS-153) Ovine Forestomach Matrix Graft as Part of Aggressive Surgical Management in Pressure Ulcers in a Young Trauma Cohort: A Pilot Retrospective Case Series

Jenna Dennis, BS – Department of Surgery – Louisiana State University Health Sciences Center; Paige Deville, MD – Department of Surgery – Louisiana State University Health Sciences Center; Patrick Greiffenstein, MD, FACS – Department of Surgery – Louisiana State University Health Sciences Center; John Hunt, MD, MPH, FACS – Department of Surgery – Louisiana State University Health Sciences Center; Alan Marr, MD, FACS – Department of Surgery – Louisiana State University Health Sciences Center; Lance Stuke, MD, MPH, FACS – Department of Surgery – Louisiana State University Health Sciences Center; Alison Smith, MD, PhD – Department of Surgery – Louisiana State University Health Sciences Center

Introduction:

Pressure ulcers present a difficult clinical dilemma. Due to concomitant complicating factors, these patients' healing trajectory can be prolonged and options for effective treatment are limited. Normally, pressure ulcers are associated with frail and elderly population. Younger patients can be overlooked when developing treatment strategies. Compared to the elderly, these patients are generally healthier but develop pressure injuries from trauma-induced paraplegia. Ovine forestomach matrix (OFM) is a commercially available extracellular matrix graft which facilitates soft tissue regeneration and has been studied in various complicated wound types. The aim of this case series was to evaluate the safety and clinical effectiveness of OFM as part of the surgical algorithm to improve outcomes in pressure injuries sustained by a younger trauma population.

Methods:

This retrospective case series consists of patients with a history of trauma resulting in immobility and who subsequently developed a pressure ulcer. Wounds were surgically debrided and OFM particulate* and/or OFM sheets^ were placed in the wound, secured, and covered with a secondary dressing.  The wound was re-evaluated at a minimum of seven days and reassessed periodically. Primary endpoints included surgical complications and device-related adverse events. Secondary endpoints include development of viable granulation tissue, time to cover exposed muscle/bone, percent area reduction, and number of OFM applications.

Results:

A total of five patients were enrolled in the study with 3 patients completing the necessary follow up. Subject one had two applications of OFM particulate and sheets. At four months, exposed muscle was covered with granulation tissue. Subject two had one application of OFM particulate and sheet. At six weeks, the wound reduced in size from 31.6 cm² to 2.6 cm² and 100% filled with viable granulation. Subject three had two applications of OFM particulate and sheet graft. At four months, the wound bed was 100% granular and area reduced from 50.5 cm² to 35.8 cm^2.

Discussion:

Pressure ulcers in young trauma patients present a challenge for healthcare providers. The promising results of this case series demonstrate the effectiveness of OFM for the treatment of these wounds in this vulnerable patient population leading to improved quality of life and fewer complications.