Negative Pressure Wound Therapy Combination with an Esterified Hyaluronic Acid Matrix Used in Preparation for Split-Thickness Skin Grafting in Complex Wounds

Introduction: Increasingly, negative pressure wound therapy (NPWT) is being used for wound closure and limb salvage. In a 12-patient case series with complex surgical wounds, the nine patients that were treated with NPWT in combination with an esterified hyaluronic acid matrix (eHAM) all received split-thickness skin grafting (STSG) and had an average wound healing time of 5.4 weeks. In a study of 31 patients with diabetic foot ulcers (DFUs), wound closure was 8.1 ± 5.5 weeks in 90% of patients following debridement and NPWT.

Objective: This was a retrospective case series using NPWT in combination with eHAM for wound bed preparation for STSG in patients with complex wounds.

Method: This case series included patients with exposed bone and tendon resulting from traumatic and surgical wounds. The wounds were ultrasonically and, in some cases, surgically debrided. The NPWT was applied at 125 mmHg with wound dressings changed 2–3 times per week. The eHAM treatment was applied underneath the NPWT dressing and, in some cases, a concentrated surfactant gel wound dressing was used. When neodermis and reepithelization was observed, the STSG was applied to the wound site for those patients that required STSGs.

Results: Following NPWT and eHAM combination treatment, the wound area and volume decreased per week following each eHAM application (ranging from 1–5 treatments). Sufficient neodermis and reepithelization of the wound bed allowed for STSG, which occurred 2–3 weeks following the final NPWT and eHAM treatment in the majority of patients. Complete wound closure was observed within 20 weeks following NPWT, eHAM, and STSG treatment.

Conclusion: This retrospective case series demonstrated that NWPT and eHAM is an appropriate treatment combination for patients with complex wounds who require STSG.