Case Series/Study
High velocity soft tissue trauma is a surgical emergency and can frequently lead to suboptimal outcomes for patients due to significant soft tissue loss, compromised exposed vital structures (such as viscera, tendons, neurovascular structures, etc), and a contaminated operative field. OFM has previously demonstrated clinical success in the surgical management of acute and chronic soft tissue defects, especially in contaminated fields providing a clinically effective option for surgeons to provide immediate coverage of exposed vital structures and rapidly build viable granulation tissue to shortened time the to definitive closure whether by skin graft, flap, or secondary intent(Bohn and Chaffin 2020).
Methods: This case series evaluates the clinical effectiveness of OFM (graft* and/or particulate^) in the surgical management of contaminated soft tissue defects as a result of high-velocity injury (such as gunshot wound or motor vehicle accident). All patients were treated with OFM as part of their inpatient surgical management following high-velocity trauma which resulted in significant soft tissue loss for the patient. Primary endpoints included time to 100% granulation tissue coverage of exposed vital structures, complications, and time to definitive closure. Secondary endpoints included the total time to closure and final cosmesis and integrity of the healed skin and soft tissue.
Results: All cases resulted in the full closure of the traumatic contaminated soft tissue injuries whether by skin graft, flap, or by secondary intention. All cases required only one surgical application of OFM prior to development of granular, viable, and functional neodermis sufficient for the second stage definitive closure method of choice. There were no secondary complications nor post-operative infections following the use of OFM. The patients were all satisfied with the final result of skin and soft tissue cosmesis as well as the quality of the final scar result. No patient required further surgical intervention following application of OFM products.
Discussion:
There are no clearly defined treatment protocols in the management of high-velocity, contaminated soft tissue trauma such as those secondary to gunshot wounds or motor vehicle accidents. The promising results of this case series highlights the use of OFM as a cost-effective and clinically effective tool in the surgical management of significant, contaminated soft tissue defects due to high-velocity trauma by reducing the number of surgical debridements, reducing the length of stay, providing coverage of exposed vital structures, and shortening the time to definitive closure. These data are easily actionable for trauma surgeons to implement into their current surgical protocol.
Trademarked Items: *Myriad™ Matrix, Aroa Biosurgery Ltd, Auckland, NZ.
*Myriad Morcells™, Aroa Biosurgery Ltd, Auckland, NZ.
References: Bohn, G. A. and A. E. Chaffin (2020). "Extracellular matrix graft for reconstruction over exposed structures: a pilot case series." J Wound Care 29(12): 742-749.