Nanofabricated Matrix for the Treatment of Surgical Wounds

Nanofiber matrix* is a product that offers a novel approach to second intention healing after skin cancer or vascular surgery. Secondary intention healing is often chosen for wounds in minimalist patients or patients with multiple comorbidities. However, the secondary intention wound-healing process can be lengthy, require multiple follow-up visits, and create a daily wound care burden for the patient or family members. Skin substitutes and wound matrix materials offer advanced options to encourage granulation tissue formation and reepithelialization. Nanofiber matrix* utilizes a commercial scale electro-spinning process to create a fully synthetic, non-woven sheet, mimicking the natural extracellular matrix of the skin. The nanofibers are composed of polyglactin-910 and polydioxanone polymers common in absorbable suture materials.

We hypothesized that the material would increase the rate of granulation tissue formation for surgical wounds healing via secondary intention and sought to determine the safety and efficacy of the product. This study was a retrospective, observational case series conducted at a single private dermatology practice. Eight patients who had undergone Mohs surgery for skin cancer removal, with appropriate wounds for wound matrix material use, were enrolled. Nanofiber matrix* was applied, and the patients were asked to follow-up at biweekly intervals until 90% epithelialization took place.

Treatment sites included: the dorsal hand, nasal sidewall, scalp (with exposed bone), and lower extremity. The average wound area was 8.1 square centimeters. The average time for 90% reepithelialization was 54.4 days.

The nanofiber matrix* can be sutured directly onto the wound bed to provide protection and coverage. Significant contraction or elicitation of an inflammatory response was not appreciated. Granulation tissue formation and reepithelialization occurred on exposed bone, cartilage, and fascia. Wound bed appearance at the study endpoint was similar to that of a wound healed by secondary intention. Patient satisfaction and cosmetic outcomes were satisfactory. Nanofiber matrix* appears to be a safe, well-tolerated, wound-healing matrix for use in surgical defects.

Trademarked Items (if applicable): *Restrata®, Acera Surgical INC, St. Louis, Missouri

References (if applicable): References:
1. Donaldson MR, Coldiron BM. Scars after second intention healing. Facial Plastic Surgery 2012;28:497-503.
2. MacEwan MR, MacEwan S, Kovacs TR, Batts J. What makes the optimal wound healing material? A review of current science and introduction of a synthetic nanofabricated wound care scaffold. Cureus 2017;9:e1736.
3. Macewan MR, Macewan S, Wright AP, Kovacs TR, et al. Comparison of a fully synthetic electrospun matrix to a bi-layered xenograft in healing full thickness cutaneous wounds in a porcine model. Cureus 2017;9:e1614.
4. Regulski MJ, MacEwan MR. Implantable nanomedical scaffold facilitates healing of chronic lower extremity wounds. Wounds 2018;30:E77-80.
5. Gohari S, Gambla C, Healey M, Spaulding G, et al. Evaluation of tissue‐engineered skin (human skin substitute) and secondary intention healing in the treatment of full thickness wounds after Mohs micrographic or excisional surgery. Dermatologic Surgery 2002;28:1107-1114.