(CS-035) Morselized Ovine Forestomach Matrix (OFM) for Limb Salvage: A Case Report on Innovative Reconstruction in Lower Extremity Trauma
Thursday, May 16, 2024
7:30 PM – 8:30 PM East Coast USA Time
Joshua Dickerson, MD; Jessica Reid, MS
Introduction: Extensive lower extremity pressure injuries often necessitate challenging clinical decisions, including considerations for major flap reconstructions or amputation [1]. For patients that are poor candidates for autologous flap reconstruction[2], there is a need for an adaptive tool that supports rapid soft tissue coverage and tissue infillto aid limb salvage efforts. This case report investigates the utilization ofmorselized ovine forestomach matrix (OFM) in reconstructing severely injured left lower limb following traumatic pressure injury. The aim was to explore the potential of morselized OFMto support coverage of exposed contaminated bonewithout the need for complex free tissue transfer reconstruction while preserving ambulation.
Methods: A 62-year-old patient with significant comorbidities presented with extensive pressure injury to lower extremity, including exposed patella and tibia with associated osteomyelitis.Prior recommendations favored above-the-knee amputation. Following surgical debridement, morselized OFMwasapplied,and partial wound closure achieved with the vessel loop shoelace technique and local skin flaps. Subsequent wound management included incisional negative pressure wound therapy (NPWT) and left iliac artery stent placement. Follow-up procedures involved staged surgery with advancementflap closure of the tibial incision with skin grafting, and local flap and skin grafting at the knee.
Results: Reevaluation on postoperative day 9 revealed well-integrated morselized OFM with vascularized tissue covering previously exposed tibial regions. Staged interventions resulted in successful coverage of bone areas with flaps and skin grafts. Imaging confirmed adequate blood flow.At 4-weeks post-op, the patient exhibited well-healed flaps and grafts, improved knee flexion, and satisfactory ambulation.
Discussion: This case underscores the successful limb salvage achieved by employing morselized OFM in conjunction with staged surgical interventions. The utilization of morselized OFM facilitated coverage of contaminated bone and functional recovery of the limb, enabling the avoidance of above-the-knee amputation and extensive free flap surgeries. The case emphasizes the potential of morselized OFM as a promising alternative in true limb salvage cases, offering insights into innovative approaches for preserving limb function and mobility in severe lower extremity trauma cases. Further research and long-term follow-ups are ongoing in a prospective registry and essential to validatethese results in a broader population.
.jpeg)
