Complex cutaneous wounds resulting from disease and injury can be difficult to heal. These wounds can result in long hospital stays, considerable health care costs, and high morbidity and mortality. The ability to rapidly reepithelialize and promote healing are essential for improving both clinical and economic outcomes. This preliminary case series provides insight into the use of synthetic hybrid-scale fiber matrix for the treatment of unique wound types studied less extensively than wounds such as diabetic foot ulcers and venous leg ulcers. The efficacy in wound closure observed with the use of the synthetic matrix to manage foot and leg ulcers[27–29] was also noted in the successful management of soft tissue lesions associated with calciphylaxis, enteroatmospheric abdominal fistula, and necrotizing fasciitis of the hand with exposed tendon.
The synthetic hybrid-scale fiber matrix offers important clinical advantages, including durability and support of wound healing, as a result of its engineered architecture, which allows for cellular infiltration, neovascularization, new tissue formation, and controlled degradation. In contrast, current treatment options are associated with significant drawbacks. In the second case reported herein, for example, bile from a fistula destroyed the STSG used for wound management, resulting in thin granulation tissue and ineffective epithelialization. The synthetic hybrid-scale fiber matrix applied to the wound remained incorporated even while exposed to bile, however, providing a scaffold for reepithelialization and enabling complete healing of the open wound. The synthetic matrix was robust; to further enhance wound healing, the matrix. was used in conjunction with NPWT with instillation dressings. Of note, the wound healing allowed the patient to more effectively manage the fistula with an ostomy device and enabled the discharge from the high-cost hospital setting and return to home after many months.
In addition to the clinical benefits provided by the synthetic matrix, preliminary cost analysis also demonstrated the economic benefits of the product. Compared with alternative treatment options, such as STSG and amniotic and placental allograft tissues, use of the synthetic hybrid-scale fiber matrix resulted in less OR and surgical time and lower total cost of care. In case 2, the first synthetic hybrid-scale fiber matrix application was performed 5 weeks after the failed STSG. Had the synthetic matrix been used from the outset, the patient might potentially have been discharged sooner, thereby further substantially decreasing the total cost of care. Furthermore, published literature has noted the potential institutional cost saving that may be obtained by a more efficient use of the OR.[30,31] Shippert analyzed 100 separate hospitals in the United States and noted that the OR cost ranged from $22 to $133 per minute, depending on the complexity of the intervention, with an average OR cost of $62 per minute nationally. Based on the economic analysis of time saved in case 2 (54 minutes) and using the reported range of per-minute OR cost of $22 to $133 as well as the national average per-minute OR cost of $62, it is estimated that use of the synthetic matrix would potentially result in significant cost savings (average, $3348 [range, $1188 to $7182]). For case 3, using the data obtained from this case (6 minutes saved in total OR time) as well as the low and average national OR per minute cost ($22 and $62, respectively),[30,31] the estimated potential savings with use of the synthetic matrix would be between $132 and $372. Based on the average 14 annualized rates of procedures, a potential institutional procedural cost savings of $1848 to $5208 might be achieved.
Additionally, indirect costs exist associated with handling and preparing biologics, such as special storage needs, requirements concerning tissue banking and tracking, and complex preparation steps, whereas the synthetic hybrid-scale fiber matrix requires no specialized storage and no tissue tracking requirements, and minimal preparation is needed prior to use. The overall differences in product handling, preparation, and the benefits of the synthetic matrix compared with the biologics represent indirect savings related to the use of the synthetic matrix.
Previous work has demonstrated that the hybrid-scale fiber matrix can be used alone to successfully manage and completely close commonly studied wounds, such as diabetic foot ulcers, venous leg ulcers, pressure ulcers, traumatic and postoperative wounds, nonvenous vascular wounds, and necrotic wounds. In this preliminary study, the synthetic hybrid-scale fiber matrix was used in conjunction with other modalities, including NPWT and a silver collagen dressing, in the management of complex wounds. The approach in this study demonstrates the versatility of the product and the possibility of use of the hybrid-scale fiber matrix with other therapies when desired, possibly resulting in synergistic effects to encourage improved healing, particularly for difficult-to-treat wounds.
Wounds. 2021;33(9):237-244. © 2021 HMP Communications, LLC