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Case Series/Study

(CS-120) The Use of a Novel Synthetic Matrix in the Rapid Closure of Tunneling Wounds and Soft Tissue Flaps

Thursday, May 16, 2024

7:30 PM – 8:30 PM East Coast USA Time

Introduction: Tunneling wounds created by pressure, infection or surgery are uniquely challenging to the healthcare provider. Reconstruction often necessitates large operations for tunnel marsupialization and/or rotational or free flaps. Often patients are sarcopenic and malnourished, leading to complications or poor outcomes. Patients often progress to hip disarticulation or other amputation. We postulate that operative sterilization of the wound followed by application of a synthetic electrospun fiber matrix can rapidly cause sealing of these challenging wounds, obviating the need for complex reconstruction.

Methods: We present a series of patients (n=11) with challenging wounds from multifactorial sources with a plethora of co-morbidities whose tunneling wounds or large soft tissue flaps were rapidly sealed after a single or serial applications of a synthetic matrix. Wounds were sterilized in the OR first with sharp excision prior to application. MRI or white blood cell sequestration nuclear medicine scans in conjunction with bone spectrometry were used to guide debridement when osteomyelitis was present and to verify resolution of infection after wound closure.

Results: We found that tunneling wounds caused by osteomyelitis and other etiologies, in addition to avulsed soft tissue flaps can be healed without large operative reconstruction. Wounds were anywhere from acute to chronic for >2 years and were traumatic, iatrogenic, or secondary to pressure ulcers with active osteomyelitis. In all cases, the wound healed or the soft tissue flap closed and where possible, post-healing MRI or white blood cell sequestration showed no further evidence of osteomyelitis. Follow up from 6 to 18 months have shown durable results with no further wounds or signs of infection.

Discussion:

An engineered synthetic, resorbable, electrospun fiber matrix in sheet or micronized form is successful in rapid closure of tunneling wounds or large soft tissue envelopes. More studies should be performed to determine patient populations who would be best served by this technique.