Abstract and Introduction
Complex cutaneous wounds resulting from disease and trauma can be difficult to heal and may require advanced treatment options. Split-thickness skin grafts (STSGs) and other biologic allogeneic and xenogeneic skin substitutes are limited in their ability to manage these lesions, and STSGs may also be limited in availability. A synthetic hybrid-scale fiber matrix, engineered with an architecture similar to native extracellular matrix, has been shown to have excellent durability and does not carry the risks of disease transmission or inflammatory response associated with biologic materials; it may offer a new option for managing these complex wounds. In this preliminary study, the synthetic matrix was used to treat 3 patients with difficult-to-treat wounds, including lesions associated with calciphylaxis, enteroatmospheric abdominal fistula, and necrotizing fasciitis of the hand with exposed tendon. Treatment with the synthetic matrix resulted in significant reepithelialization and wound healing. The successful results suggest that the synthetic matrix enables healing of complex cutaneous wounds and may be a reasonable alternative to STSG, even in particularly challenging cases.
Complex cutaneous wounds incurred from disease and trauma can be difficult to heal and may require advanced treatment options. In cases of calciphylaxis, a rare, life-threatening syndrome of vascular calcification in which occlusion of microvessels in the subcutaneous adipose tissue and dermis results in ischemic skin lesions, sepsis originating from skin lesions is the most common cause of death, resulting in a high mortality rate of 30% to 80%. The biophysiology of the calciphylaxis lesion has been well described by Nigwekar et al and Magro et al. Given the high morbidity and mortality associated with complex calciphylaxis skin lesions, rapid and effective healing of these wounds is critical. Treatment options to effectively address calciphylaxis lesions are varied and involve local as well as systemic therapies.[4–6]
Similarly, the management of complex abdominal trauma with the open abdomen technique has been associated with an increased incidence of complications, including wound dehiscence, enteric fistula formation, and skin lesions, which result in increased morbidity.[7–13] The care of these patients is associated with increased costs owing to multiple factors, including prolonged length of hospital stay.[7–13]
Necrotizing fasciitis is a life-threatening, rapidly spreading infection of the soft tissue characterized by necrosis and sepsis and is accompanied by severe systemic toxicity.[14,15] Given the severity of the condition, rapid diagnosis and immediate management are required.[14,15]
Split-thickness skin grafts (STSGs) may be used to manage complex cutaneous wounds; however, there are circumstances in which they are limited in availability or obtaining an STSG may be imprudent (eg, calciphylaxis, debilitated patient). Drawbacks of STSGs include the need for an additional surgical procedure, use of anesthesia, use of an operating room (OR), creation of a second wound, and donor site pain and morbidity, including donor site skin infection, keloid scarring, and necrosis.[16–18] Other biologic allogeneic and xenogeneic skin substitutes also have limitations, including poor durability and longevity; they also carry the risk of disease transmission and undesirable inflammatory response.[18,19]
A fully synthetic, biocompatible, resorbable electrospun matrix composed of hybrid-scale fibers, engineered with an architecture similar to native extracellular matrix, may provide a new option for treating the lesions.[19,20] Of note, this matrix is without the risks of disease transmission or inflammatory response associated with biologic materials.[19,20]
The objective of this preliminary study was to evaluate the use of the synthetic hybrid-scale fiber matrix as a scaffold for managing 3 types of complex skin lesions: calciphylaxis, abdominal fistula, and necrotizing fasciitis of the hand and forearm.
Wounds. 2021;33(9):237-244. © 2021 HMP Communications, LLC