A retrospective review of soft tissue reconstruction in volumetric soft tissue defects

Introduction: There are a variety of diagnoses that require the surgical debridement of nonviable tissue and result in a volumetric soft tissue defect. These wounds will typically reveal exposed muscle, bone, tendon, and vasculature that require coverage with a dermal layer prior to skin grafting. In some cases where flap procedures are inappropriate or not possible, dermal matrices represent an alternative reconstructive option for these volumetric soft tissue defects. With dermal matrices becoming increasingly available and technologically advanced, we evaluated an ovine derived extracellular matrix graft (OFM) in the reconstruction of these defects. In addition to the OFM sheet grafts^, a morselized or powdered OFM† product was used to facilitate an increase in the surface area contact of the OFM products with these irregular wound beds. Methods: Three cases of soft tissue defects exhibiting volumetric soft tissue loss underwent reconstruction using an OFM graft and morselized OFM as a dermal matrix. Grafts were fixed directly into defects for immediate coverage and subsequently temporized defects via granulation tissue formation for later skin graft or secondary closure. Defect granulation and epithelialization were monitored until closure and the final aesthetic and functional outcomes were evaluated.Results: Complete granulation of the graft was achieved in all cases. Granulation tissue resulting from the graft was suitable for skin grafting, with complete reepithelialisation in two to three weeks where a skin graft was applied to the wound bed. Patients were satisfied with the outcomes achieved.Discussion: The present series highlights the use of an extracellular matrix sheet and morselized graft for the reconstruction of defects with volumetric soft tissue loss. While such dermal matrices do not supersede or replace flap procedures, they represent an alternative option on the reconstructive ladder in cases where flap procedures are not appropriate or possible.