How I Treat: Soft Tissue Reconstruction Case Presentation

• 59-Year-old male presented from outside hospital after initial debridement for a lower extremity necrotizing soft tissue infection (NSTI) (Figure 1)
• Past medical history significant for Diabetes Mellitus II, peripheral arterial disease, obesity, former nicotine smoker (30+pack year history).
• Suffered right leg infection secondary to a puncture wound from a catfish spine envenomation that resulted in a NSTI.
• Initial debridement wound management and intravenous antibiotics were administered by an outside hospital. The patient was transferred for further wound management and soft tissue reconstruction.

Figure 1

• Due to persistent necrotic tissue, friable wound edges and areas of undermining an additional debridement occurred resulting in a wound roughly 35 cm x 20 cm x 1 cm.
• Post debridement, the defect had significant depth, irregularity, undermining and exposed structures (Figure 2)
• Myriad Morcells (500 mg) were hydrated and placed over the irregular wound bed surrounding the exposed extensor tendons of the foot (Figure 3)
• Myriad Matrix sheets (four devices, measuring 10 x 20 cm each) were placed to cover the entire soft tissue defect (Figure 4)
• The wound was dressed with a silver silicone contact layer and NPWT (125 mmHg) and scheduled to be evaluated 7 days later.

• 1 Week from initial procedure. 100% take of the Myriad Matrix and granulation tissue beginning to proliferate at the edge of the device as the device as it began to incorporate. There was no sign of infection and coverage of the tendons. NPWT was continued.
• 3 Weeks from initial procedure robust granulation tissue present on the proximal portion of the defect and the volume of the defect. There was no sign of infection or purulence in the wound bed and there was complete coverage of the tendons. The patient continued NPWT following discharge from the rehab center due to lack of insurance coverage. Follow up was continued at an outpatient wound care center.
• 10 Weeks from initial procedure and there is 95% granulation of the Myriad Matrix. Robust bed of granulation tissue with no signs of infection.
• 13 Weeks from initial procedure with 100% granulation of the Myriad Matrix. No complications and  wound bed sufficiently prepared for a split thickness skin graft to achieve definitive closure (Figure 5)

• NSTIs are challenging wounds to manage for a multitude of reasons, one being the difficulty in reconstructing all the missing tissue following multiple debridement’s. In this case the patient was able to maintain a fully functionally lower extremity despite the severity of their injury.
• This case report highlights the ability for Myriad Matrix and Myriad Morcells to aid the body in building new functional soft tissue following a single application.
• The addition of Myriad to the wound bed allowed for continued inflammatory modulation while also providing a scaffold for new soft tissue reconstruction. While Myriad Matrix may typically incorporate in 1-2 weeks, complete incorporation of the device in this instance was delayed (12 weeks) most likely due to the patient comorbidities, depth and complexity of the defect.
• Myriad shows promise as a single application bioscaffold to accelerate soft tissue reconstruction in necrotizing soft tissue infections.   

Myriad Matrix™ and Myriad Morcells™ are trademarks of Aroa Biosurgery Limited.

Dr Abigail Chaffin has a consultancy agreement with AROA Biosurgery Limited.

October 2021 | MKT.1747.00