Biological Reactivation of the Clinically Senescent Wound Using a Novel Microvascular Tissue Graft in Complex Lower Irradiated Leg Wounds

Background: Chronic tissue ischemia leads to cellular senescence and death. Microvascular tissue, composed of a variety of tissue matrix components and bioactive factors, is a key structural unit for maintaining tissue viability. A novel regenerative structural tissue product derived from processed human microvascular tissue (PMVT*)[1-3] was utilized in refractory non-healing irradiated leg wounds in two patients with comorbidities precluding traditional surgical interventions.

Case Series: Patient 1 was a 76-year old female presenting with a non-healing wound three months after a Mohs' procedure for basal cell carcinoma on the lower leg.  The patient was on steroids and Methotrexate for reasons unrelated to the wound. Conventional treatment and weekly application of dehydrated amnion/chorion membrane failed to decrease wound size. 

Patient 2 was a 29-year old male with metastatic malignancy presenting with a non-healing lower leg wound after excision of a soft tissue sarcoma followed by radiation. The wound was treated by amniotic membrane, followed by skin grafting. The skin graft failed and the tissue layer underneath dessicated, leading to bone exposure. Cancer immunotherapy was administered so further surgery was not possible. PMVT was applied, with the expectation that a vascularized flap would ultimately be required given the exposed bone. 

Results: Following debridement PMVT was applied weekly until wounds healed.  Restored vascularity of the healing tissue was clinically evident following PMVT application, and complete wound healing resulted in both cases.  In the case of bone exposure, soft tissue grew from the periphery, a piece of exposed cortex was separated, and the entire wound unexpectedly healed, obviating the need for a vascularized flap. PMVT is a potent new senescence-reversing intervention that activated healing and drove complete wound closure in refractory irradiated defects.

*mVASC® - MicroVascular Tissues, Inc., San Diego, CA