(CS-102) Initial experience with flowable micronized porcine urinary bladder matrix in complex wound management

Hannah Baker, PhD – Integra LifeSciences; Claire Witherel, PhD – Integra LifeSciences

Introduction:

Wound management in the setting of trauma surgery can be complicated by several factors including involvement of multiple tissue types, contamination, and irregular wound geometries. The use of skin substitutes may provide support within the reconstructive ladder when faced with the distinct challenges presented by traumatic wounds.

Porcine derived urinary bladder matrix (UBM) particulate and sheets have been studied for use in a variety of complex wounds^1-3. UBM devices have been found to be associated with a pro-remodeling host immune response in support of wound closure². More recently, a flowable delivery configuration of the UBM particulate in the form of a paste has been cleared for use in the same indications as the particulate and sheet devices, including traumatic wounds with tunneling and undermining.

Methods:

In this report, we have detailed a trauma surgeon’s initial experience with flowable UBM. The flowable device comes with a syringe preloaded with UBM particulate and an empty syringe to be filled with sterile saline followed by connection of the syringes, mixing, and deployment of the UBM paste through a flexible tip. Pertinent patient demographics and history, initial wound presentation, notes on device handling and application, and available early follow-up outcomes (≤ 90 days) were collected.

Results:

We have outlined three cases wherein UBM flowable devices were applied in complex open abdominal wounds with tunneled and undermined features. Management entailed thorough debridement coupled with application of the flowable UBM alone or in combination with other UBM configurations. To date, all evaluated wounds have progressed toward closure. Initial experience with the device handling was positive and supported the utility of the configuration for applying UBM paste in complex geometries.

Discussion:

This report highlights the early use of flowable UBM by a trauma surgeon. Previous studies have demonstrated use of UBM paste in tunneling aspects of wounds in support of wound closure. Early reporting on flowable UBM described in this series of complex trauma wounds further corroborates prior findings with UBM paste. Although limited, this small series provides impetus for further research on flowable UBM in traumatic wounds as well as other wounds complicated by tunneling and undermining.