(CS-164) Outpatient reconstruction of traumatic dog bite avulsion injuries of the lower extremity with Kerecis (®) acellular fish graft and negative pressure wound therapy in a two-stage procedure
Thursday, May 16, 2024
7:30 PM – 8:30 PM East Coast USA Time
Introduction: Dog bite avulsion injuries are common sources of morbidity requiring initial treatment in the emergency room. Management of skin avulsion injuries of the lower extremity may require coverage with large flaps or skin grafts.Use of Xenograft can be combined with negative pressure wound therapy in a two staged algorithm to optimize coverage of deep structure elements, wound bed preparation and ultimately epidermal regeneration.
Methods: We performed this technique in a 65-year-old -male who sustained a large full thickness (muscle and fascia) avulsion injury of the left thigh from a pit bull dog attack. Initial treatment in the ED resulted in inadvertent primary closure of the wound. Patient underwent debridement and compartment decompression. Patient was discharged 2 days later to our wound center.An algorithm of pH testing, wound culture, thermal free- tissue excision and hypochlorous acid-soaked white sponge with negative pressure wound vac therapy was applied for 2 weeks. The Peri wound was undermined and a 3 cm free flap sutured over the visible muscle rim.A single layer of meshed Kerecis Omega3 Marigen ® was applied with negative pressure wound therapy and compressive dressings for 2 weeks.Graft incorporation and wound bed viability was assessed at 2 weeks post graft application.
Results: We observed a robust hyper-granular over exposed muscle and fascia within week 1 of NPWV therapy and hypochlorous acid.At week 3, Kerecis xenograft resulted in complete incorporation, decrease in pain (Numerical Pain Rating Scale of 2) and dermal appendage migration and week 5 of complete epidermal coverage.Overall appearance of the reconstructed area was satisfactory at week 5 (Vancouver Scar Scale Score of 9)
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