Augmented Flap Reconstruction of Complex Pressure Ulcers Utilizing Novel Nanofiber Tissue Matrix

Flap reconstruction of pressure ulcers offers an important clinical means of decreasing morbidity in hospitalized patients. Unfortunately, complication rates following pressure ulcer reconstruction utilizing flap coverage are reportedly high as patients commonly possess multiple risk factors for postoperative dehiscence, infection, and ulcer recurrence. The primary aim of this case series was to examine whether preparation of pressure ulcers with a novel nanofiber tissue matrix may reduce the rate of wound-healing complications, readmissions, and re-operations following flap reconstruction. Cases involving pressure ulcer coverage at a long-term acute care facility were reviewed and clinical outcomes were summarized.

Case 1 involved a 50-year-old female who presented with a 3-month-old ischemic ulcer on the posterior aspect of the lower leg measuring 12 cm x 6 cm. The ulcer was initially debrided and treated with nanofiber tissue matrix (Restrata, Acera Surgical, Inc.) in order to encourage granulation tissue formation and improve tissue quality. Four weeks later, rotational flap reconstruction was performed. Two weeks postoperatively, the wound was intact with healthy margins and no signs of dehiscence or infection.

Case 2 involved a 58-year-old female who presented with a 2-month-old pressure ulcer on the left heel measuring 4.3 cm x 3 cm. The ulcer was initially debrided and treated with nanofiber tissue matrix and reconstructed with rotational flap four days later. One week postoperatively, the wound was intact with healthy margins and no signs of dehiscence or infection.

Together, these results suggest that pre-conditioning of complex pressure ulcers with nanofiber tissue matrix may improve tissue quality and maximize the efficiency and success of flap coverage. Futures studies will aim to build upon these findings and expand the investigation of augmented flap reconstruction to a larger subset of patients across multiple health-care facilities.