Effects of Negative Pressure Wound Therapy on Complex Extremity Wounds Requiring Coverage with a Bilayer Wound Matrix: a Retrospective Analysis

The treatment of complex extremity wounds is a technically challenging problem facing all reconstructive surgeons. The use of the Bilayer Wound Matrix (IBWM, Integra LifeSciences) and negative pressure wound therapy (NPWT) has shown promise in the treatment of these wounds in small case series. In this cohort study, we compare the use of IBWM alone with IBWM combined with NPWT. We hypothesized patients treated with the acellular dermal matrice (ADM) and NPWT would have fewer postoperative complications, shorter recovery times, and fewer additional grafts.

The records of all patients undergoing extremity wound coverage with IBWM at a single academic institution were queried from electronic medical record. Data collected included demographic information, wound etiology, number of grafts required, and post-operative complications.

Preliminary data revealed a total of 109 patients undergoing treatment with the ADM for a complex extremity wound, 62 patients were treated with ADM and NPWT, and 47 patients treated with ADM alone. The most common etiology of these injuries was trauma. At 3 weeks postoperatively, 2 patients from the ADM + NPWT group and 7 patients in the ADM alone group required reapplication of matrice before definitive coverage with a split-thickness skin graft (STSG).

The combination of IBWM and NPWT can reduce the number of reapplications and postoperative complications in the setting of complex extremity wounds. Traditionally, these injuries have been treated with delayed closure using STSGs or technically challenging flap procedures. Treatment with the ADM and NPWT decreases the time from initial injury to definitive closure as well as requires less technical skill than traditional methods, increasing the availability of complex wound treatment to more than just specialty surgery centers. Thus, the use of IBWM and NPWT has the potential to improve both outcomes and availability of complex wound treatment in the setting of extremity wounds.

Trademarked Items (if applicable): Integra

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