OASIS® Matrix Products in closing surgical complications and trauma wounds

Because wound healing is a complex process requiring the activation and synchronization of intra/intercellular and extracellular elements, patients with a dysfunctional or missing extracellular matrix (ECM) cannot support proper wound closure.¹ While a growing number of skin substitutes are available to assist the healing of post-surgical and traumatic wounds, not all support advanced tissue repair like OASIS Matrix.

Naturally derived from porcine small intestinal submucosa (SIS), similar to human dermis. OASIS Matrix provides a natural scaffold that supports cellular migration and vascular growth.^2-14

Frances Collini, MD, FASC, a board-certified plastic surgeon and Medical Director of the Renaissance Center for Plastic Surgery in Shavertown, Pennsylvania brings us two cases where he successfully used OASIS Matrix to surgically close difficult wounds.

Case Study: Surgical Complication Following Mastectomy

Diagnosis

Dr. Collini’s first case involves a 53-year-old woman post breast cancer following a bilateral radical mastectomy and bilateral transverse rectus abdominus myocutaneous (TRAM) flap reconstruction. 

Postoperatively, the patient developed numerous infectious complications. The left TRAM flap failed to heal despite aggressive local treatment measures. Physical examination revealed extensive skin infections and biofilm production in the left breast.  In addition, the patient was accused of “self-inflicting” the open wounds and advised to see a psychiatrist.

In post mastectomy care, the goal is to minimizes complications and yield satisfactory esthetic and functional outcomes, with minimal inconvenience to the patient, and good pain control. While these surgeries are generally associated with low rates of surgical morbidity, postoperative complications do arise and can include seroma, infection, hematoma, mastectomy flap necrosis, wound dehiscence, and persistent postsurgical pain.

To manage infections and tissue failures that may arise, a growing number of surgeons turn to skin substitutes that support advanced tissue repair such as OASIS ULTRA Tri-Layer Matrix.  Naturally derived from porcine small intestinal submucosa (SIS), OASIS is similar to human dermis.

Procedure

For Dr. Collini’s patient, treatment required complete and total resurfacing by removal of the TRAM flap skin and coverage with OASIS ULTRA Matrix followed at a later stage by coverage with a split thickness skin graft (STSG).

Upon surgical removal of epidermis, dermis and subcutaneous tissue from the TRAM flap, the team identified a subcutaneous seroma cavity infected with methicillin resistant Staphylococcus Aureus. The patient was treated with appropriate antibiotics.

Two applications of OASIS ULTRA Matrix were applied followed by a split thickness skin graft.

Outcome

The patient achieved a complete take of the split thickness skin graft. 

Case Study: Dog Bite Traumatic Injury to Arm

Diagnosis

Dr. Collini’s second case features a 41-year-old woman with a 15-year history of Rheumatoid Arthritis, who was on a regimen of steroid treatment at the time of the attack. She suffered a dog bite to left forearm. Both sides of her forearm were penetrated, leaving the skin torn from the underlying fascia 85% circumferentially around the forearm, involving muscles and tendons.  

Procedure

Corticosteroid treatments were discontinued prior to surgery. Surgical treatment included surgical debridement, muscle and tendon repair and placement of OASIS ULTRA Matrix x 2 applications.

By Day-12, the OASIS ULTRA Matrix had fully incorporated into the wound and showed the formation of a significant layer of granulation tissue at the base of the open wound. Dr. Collini determined the wound was ready for the application of a split thickness skin graft. By Day 21, there was 100% graft take despite restarting corticosteroids. 

Outcome

2.5 months after application of the split thickness skin graft, the wound is close.

Why OASIS Matrix Products?

Not all biologics support advanced tissue repair, but OASIS Matrix Products can help jump start cell proliferation to repair ECM through each stage of wound healing.^4-6 Naturally derived from porcine small intestinal submucosa (SIS), similar to human dermis, OASIS Provides a natural scaffold that supports cellular migration and vascular growth.^7-20

OASIS Matrix products are available in multiple forms and sizes: a single layer of fenestrated naturally derived ECM for the shortest timeline to complete integration; two meshed/fenestrated layers for fixation and retention of sutures and staples; three meshed/fenestrated layers (OASIS ULTRA Tri-Layer Matrix) which allows for weekly visits and challenging wounds with degrading enzymes. Additionally, OASIS XL Matrix is a two layer matrix option that provides perforated layers for 600 cm² of coverage, ideal for large surface area wounds and burns. And finally, OASIS MICRO Matrix, a micronized powder that the body can breakdown more easily indicated for tunnelling and undermined wounds. OASIS Matrix is indicated for the management of a wide range of wounds including: partial-and full-thickness wounds, pressure ulcers, venous ulcers, chronic vascular ulcers, tunnelled and/or undermined wounds, diabetic ulcers, trauma wounds (abrasions, lacerations, second-degree burns*, skin tears), draining wounds, surgical wounds (donor sites/grafts, Post-Mohs’ surgery, post-laser surgery, podiatric, wound dehiscence).

OASIS Matrix is indicated for the management of a wide range of wounds including: partial-and full-thickness wounds, pressure ulcers, venous ulcers, chronic vascular ulcers, tunnelled and/or undermined wounds, diabetic ulcers, trauma wounds (abrasions, lacerations, second-degree

• 54% of patients with DFUs achieved complete wound closure at 12 weeks in an OASIS ULTRA Tri-Layer Matrix + Standard of Care (SOC) group vs 32% of patients receiving SOC alone (p=0.021).¹⁵
• 55% of patients with VLUs achieved complete wound closure at 12 weeks in OASIS Matrix + SOC group vs 34% of wounds receiving SOC alone (p=0.0196).¹⁶
• 55% of patients with pressure ulcers in the OASIS Matrix + SOC group saw a 90% reduction in ulcer surface area compared to 38% in the SOC group (p=0.037).¹⁷

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References:

1. Clark RA. Fibrin and wound healing. Ann NY Acad Sci. 2001;936:355-367.
2. Internal Cook Biotech Document: 97-010 VIIA.
3. Internal Cook Biotech Document: 97-010 VIIB. 6. Internal Cook Biotech Document: 07-057.
4. Internal Cook Biotech Document: 00-027.
5. Internal Cook Biotech Document: 98- 084.
6. Brown B, Lindberg K, Reing J, Stolz DB, Badlyak SF. The basement membrane component of biologic scaffolds derived from extracellular matrix. Tissue Eng. 2006; 12(3): 519-526.
7. Hodde JP, Badylak SF, Brightman AO, Voytik-Harbin SL. Glycosaminoglycan content of small intestinal submucosa: a bioscaffold for tissue replacement. Tissue Eng. 1996; 2(3): 209-217.
8. Hodde JP, Janis A, Ernst D, Zopf D, Sherman D, Johnson C. Effects of sterilization on an extracellular matrix scaffold: Part 1. Composition and matrix architecture. J Mater Sci Mater Med. 2007; 18(4): 537-543.
9. Internal Cook Biotech Document: 96-006.
10. Hurst RE, Bonner RB. Mapping of the distribution of significant proteins and proteoglycans in small intestinal submucosa by fluorescence microscopy. J Biomater Sci Polym Ed. 2001; 12(11): 1267-1279.
11. Kinn PM, Holdren GO, Westermeyer BA, et al. Age-dependent variation in cytokines, chemokines, and biologic analytes rinsed from the surface of healthy human skin. Sci Rep. 2015; 5: 10472. doi: 10.1038/srep10472.
12. Son ED, Lee JY, Lee S, et al. Topical application of 17beta-estradiol increases extracellular matrix protein synthesis by stimulating tgf-Beta signaling in aged human skin in vivo. J Invest Dermatol. 2005; 124(6): 1149-61.
13. Kabelitz D, Schröder J-M (eds): Mechanisms of Epithelial Defense. Chem Immunol Allergy. Basel, Karger, 2005, vol 86, pp 22-41. 17. McGrath JA, Eady RAJ, Pope FM. Anatomy and organization of human skin. In Burns T, Breathnach S, Cox N, Griffiths C, editors, R.
14. Cook Biotech Inc. Internal Document #07-001
15. Cazzell SM, Lange DL, Dickerson JE, Slade HB. The management of diabetic foot ulcers with porcine Small Intestine Submucosa Tri-Layer Matrix: A randomized controlled trial.
16. Mostow EN, Haraway GD, Dalsing M, Hodde JP, King D; OASIS Venus Ulcer Study Group. Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial. J Vasc Surg. 2005;41(5):837-843.
17. Brown-Etris M., Milne C., Hodde J. An extracellular matrix graft (OASIS wound matrix) for treating full-thickness pressure ulcers: A randomized clinical trial. J Tissue Viability. 2019;28(1):21-26.

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Products may not be available in all markets because product availability is subject to the regulatory and/or medical practices in individual markets. Please contact your Smith+Nephew representative or distributor if you have questions about the availability of Smith+Nephew products in your area.

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