Abstract and Introduction
Abstract
Background. Management of complicated open wounds represents a challenge when reconstructive options are not applicable. Urinary bladder matrix (UBM) provides a biocompatible material that allows inductive tissue remodeling.
Methods. The use of urinary bladder matrix in the treatment of 5 patients with complicated open wounds that failed to heal with conventional therapy is presented.
Results. A 3-year old male sustained a second-degree oil burn measuring 8 cm x 4 cm to his dorsal forearm; UBM was applied weekly and the wound epithelialized in 3 weeks. A 52-year old male sustained massive second and third degree burns to his leg after a fire; UBM was applied weekly and the wound epithelialized in 28 weeks. A 61-year old female sustained a severe crushing injury to her right knee. A gastrocnemius muscle transfer and rectus abdominus muscle free flap transfer both failed, then UBM and vacuum-assisted closure therapy were applied and the wound epithelialized in 24 weeks. A 54-year old female underwent a breast mastectomy and immediate reconstruction with pedicled transverse rectus abdominus flap. The patient developed partial necrosis and the wound was managed with UBM and vacuum-assisted closure therapy. The wound epithelialized in 12 weeks. A 36-year old female sustained severe degloving injuries to both hands with exposed metacarpals. Weekly application of UBM provided tissue remodeling over the bones, which allowed successful skin grafting and closure.
Conclusions. These experiences show UBM to be an effective method in management of complicated open wounds in select cases. Further studies need to be implemented to confirm this conclusion.
Introduction
Annual wound care cost to the US health care system exceeds 20 billion dollars. This estimate is largely inflated by the costs of wound complications including infection, extended physician care, repeat surgical intervention, and prolonged hospital stay. A chronic dermal ulceration can cost up to $40,000 to heal, and costs often increase as recurrence rates exceed 50% within 18 months of healing. Beyond financial costs, the loss of integrity of large portions of the skin due to injury or illness can result in significant morbidity and mortality.
The principal goal of wound management is to achieve rapid wound closure and a functional, aesthetically acceptable scar. Extraordinary advances in cellular and molecular biology have expanded our understanding of basic molecular processes underlying wound repair and tissue regeneration. However, translating this understanding into improved management of complicated open wounds continues to be a challenge, particularly when reconstructive options are not applicable. This paper presents a case series of the use of urinary bladder matrix (UBM) scaffold for treatment of complicated open wounds.