Urinary Bladder Matrix Powder to Help Achieve Wound Closure in Tunneling Wounds

In this clinical video, the presenter shares the results of utilizing a urinary bladder matrix powder to promote wound closure in tunneling wounds, specifically highlighting a case of a diabetic foot ulcer with Charcot foot. Data from this poster were presented at the SAWC Fall in Las Vegas, Nevada (October 29-31, 2021).

This video was sponsored by Integra LifeSciences.

Transcript

Hello. I am Michael Desvigne, plastic surgeon out of Glendale, Arizona. I'm here on behalf of Integra. I'm here to discuss a poster presented at SAWC Fall 2021 where we looked at the utilization of porcine bladder matrix, specifically Cytal, as well as MicroMatrix in soft tissue reconstruction, particularly with tunneled wounds.

Generally, as a plastic surgeon, we are faced with challenging wounds with chronicity as well as, perhaps, tunneling with soft tissue deficit. These wounds are particularly difficult with regard to flap reconstruction. Many times, these patients are not candidates for flap reconstruction.

In our particular poster, what we presented were 3 specific cases utilizing the porcine bladder matrix, Cytal as well as MicroMatrix, in utilization for tunneled wounds. In the first case, what we'll see in a detailed discussion is the use of this tissue form with a tunneled wound to the foot.

In the first case presented, we'll go into detail as this case particularly represents a tunneled wound through and through to the plantar surface of the foot. This obese, diabetic, neuropathic patient presented with a large wound that was tunneling that initially had undergone abscess and drainage followed by excision of the ulcer and debridement.

The 2 wounds communicated with an extensive tunneling from 6 to 8 cm. With that, there was a paucity of soft tissue reconstruction. I elected to utilize a porcine bladder matrix. Specifically, the MicroMatrix, approximately 1000 mg, was utilized as a paste form. This was done by mixing the initial MicroMatrix with about 3 to 5 ccs of normal saline.

The mix was basically customized so that it was flowable enough that it could be utilized with a 5-cc syringe. The area was injected and then followed up by filling of the defect. The addition of Cytal, the membrane matrix, was placed topically. Negative pressure therapy was then utilized postoperatively. As you'll see, on day number 1, we had a good seal.

By day 3, upon evaluation, we had now a vascularized tissue bed. The wound appeared without evidence of infection. Negative pressure was then continued for the next 2 weeks. At week 6, you could see now a nearly completely healed epidermal closure of both wounds. By week 8, there was complete closure.

The benefit here was that this patient did not need an additional surgical intervention. No flap mobilization was needed. The patient was able to recover uneventfully. We saw her at 1-year post-op. She still continued to ambulate without need for further surgical intervention.

The benefit in this particular case as well as the other 2 cases shown shows that there is utilization of this porcine bladder matrix to help with soft tissue reconstruction particularly when challenged with a tunneled wound. In this particular case, we saw complete closure. In the 2 additional cases, we also had complete closure without the need for surgical intervention.

While further study is needed, in this point we feel that there is benefit of the utilization of porcine bladder matrix, specifically the MicroMatrix as well as the Cytal for soft tissue reconstruction, particularly in tunneled wounds.