Abstract
Chronic soft tissue defects are notoriously difficult to heal. Surgical reconstruction of chronic defects using tissue flaps is a routine approach for closure of challenging chronic defects. Due to the poor tissue quality of chronic defects and associated inflammation, infection and impaired blood supply the success of flap closure is marred by reported complication rates of 25–58%. Extracellular matrix (ECM)-based graft materials are commonly used for resolving chronic wounds and in plastic and reconstructive procedures to create a scaffold for tissue regeneration. We hypothesized combination use of ECM grafts with tissue flaps in a single-stage surgical procedure would reduce complications and improve outcomes in the closure of chronic soft tissue defects. We report a case series (n = 9) of chronic soft tissue defect reconstruction using this modified procedure of ECM graft augmented flap closure. Defects included pressure injuries and surgical dehiscence and ranged in wound age from 5 months to 7 years. Successful uncomplicated healing was achieved in six defects. Post-operative complications (dehiscence) occurred in two defects, however, these healed via secondary intention without additional surgical intervention. All healed defects exhibited acceptable cosmesis and “normal” function, with 100% patient satisfaction. Augmentation of tissue flaps with ECM graft materials in this modified single-stage procedure may improve outcomes and minimize typical complications encountered in flap closure of chronic defects attributed to inflammation, infection, hypoperfusion, and dead space.
Highlights
Flap reconstruction is a well-established approach to the closure of chronic soft tissue defects post-operative complications such as infection, dehiscence, and re-occurrence are relatively common
We hypothesized that the concurrent placement of an underlaid Extracellular matrix (ECM) graft during flap reconstruction of chronic wounds may reduce surgical complications by reducing inflammation of the proximal tissues and stabilizing the flap
We hypothesized that complications following flap reconstruction of chronic defects may be reduced by the complementary use of an ECM graft to stabilize and augment the surgical flap and underlying tissues
Summary
Flap reconstruction is a well-established approach to the closure of chronic soft tissue defects post-operative complications such as infection, dehiscence, and re-occurrence are relatively common. A prospective study of 276 pressure injuries closed by flap advancement demonstrated a complication rate of 58%, where wound dehiscence (31.2%) and re-occurrence (28.6%) were the most frequent complications [2]. Extracellular matrix (ECM) grafts are absorbable bioscaffolds commonly used across a range of plastic and reconstructive procedures to scaffold soft tissue repair These technologies provide a temporary scaffold for cellular infiltration and capillary formation while providing protective coverage and reinforcement of the defect until the bioscaffold is absorbed into the regenerating soft tissues [3]. Many different ECM grafts are clinically available and differ in the origins of the source tissue (e.g., human, porcine, bovine, equine) and the processes used to decellularize the tissue to remove nuclear and cellular material while preserving the structure and composition of the tissue ECM
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