How I Treat: Post-Surgical Dehiscence Case Presentation

• 52-Year-old male
• PMHx of DMII, Charcot arthropathy, PAD
• The patient was receiving wound care for 6 months for a plantar cuboid ulceration until he elected to undergo Charcot reconstruction
• Three weeks following the procedure, the patient experienced surgical dehiscence with formation of a large hematoma
• The hematoma and necrotic tissue were excised with the resulting defect exposing bone and joint, with tunnelling (Figure 1)

• After extensive debridement, Myriad Morcells (1000 mg) was applied deep into the tunnel and over the bone (Figure 2 and 3)
• Myriad Matrix (5x5 cm, 3-Layer) was placed over the Myriad Morcells
• Myriad was then bolstered with NPWT (125 mmHg)

• 1 Week. Myriad Matrix was well adhered and there were no complications. NPWT changes were performed twice per week. (Figure 4)
• 2.5 WeeksRobust granulation tissue and 100% of the depth was filled. There was complete coverage of the exposed bone and joint. No complications occurred. The patient was a poor candidate for a split thickness skin graft (STSG), therefore a return to the OR was planned to remove the external fixator and further debridement, with a second application of Myriad Matrix 5x5 cm, 3-Layer (Figure 5)
• 5 Weeks (5 days post-second application of Myriad Matrix). The second Myriad Matrix graft was well adhered. A bolster dressing was applied, and patient continued to be complication-free
• 6 Weeks (<6 weeks post-second application of Myriad Matrix). Small amounts of residual Myriad Matrix were removed revealing 100% granulation tissue. The entire depth of the original defect was filled providing coverage to the previously exposed bone and joint. The wound was covered with a sheet of Endoform Natural™ to facilitate healing by secondary intention (Figure 6)
• 10 weeks.The wound is 80% epithelized with no complications (Figure 7)
• The patient avoided leg amputation and has returned to normal activity with a functional foot

• The combination of Myriad Morcells and Myriad Matrix can be used to help achieve rapid coverage of exposed bone even in patients with impaired healing, minimizing complications such as sepsis, amputation, and hospital re-admission
• This case report highlights the ability for Myriad Matrix and Myriad Morcells to assist in the rapid formation of a robust bed of granulation tissue and shorten the time to full closure by STSG or secondary intention

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

Dr Kaufman has a consultancy agreement with Aroa Biosurgery.

November 2021 | MKT.1763.00