Dermal Matrices: Game Changers in Leg and Foot Soft Tissue Reconstruction? A Case Series

Abstract

The present article aims to present the use of dermal matrices in severe degloving, avulsion, and necrotizing injuries of the leg and foot in 3 patients. Conventional reconstruction would require the use of free flaps, since exposure of vessels, nerves, joints, and tendons rendered the mere resurfacing with skin grafts insufficient, and extensive cutaneous detachment precluded the use of local fasciocutaneous flaps. All injuries underwent thorough and repeated surgical debridements and wash outs, followed by negative pressure wound therapy (NPWT). Once negative tissue cultures were obtained, the extremities were resurfaced with dermal matrix and immediately covered by split thickness skin grafts. NPWT on the grafted area for a week effectively secured the grafts on the recipient area. Complete healing was achieved in all grafted areas within 7 to 12 days. The function of joints and tendons as well as the quality of resurfacing at the weight bearing areas were tested and found satisfactory within a follow-up period of 5 to 15 months. The use of combined NPWT and dermal matrices in carefully selected patients provides a reliable and durable reconstructive option for leg and foot injuries with satisfactory functional outcomes.

Management of Hardware-Exposed Soft Tissue Defects Using Dermal Substitutes and Negative Pressure Wound Therapy

“…Recently, studies showing a high success rate when combined treatment with dermal matrix and NPWT were performed before skin grafting were published 8–10 . It has been reported that NPWT can accelerate the integration of artificial dermis into the wound bed and provide controlled continuous or intermittent subatmospheric pressure 10 .…”

“…If the combination treatment using NPWT dressing on the artificial dermis suggested in our study can be applied to cover the exposed bone, tendon, and hardware structures with granulation tissue, STSG can be possible. In these cases, using STSG compared with flaps provides certain advantages, including technical autonomy of the vascular anatomy, early wound closure with minimal donor site morbidity, and the possibility of other options for later reconstruction 8 …”

“…In these cases, using STSG compared with flaps provides certain advantages, including technical autonomy of the vascular anatomy, early wound closure with minimal donor site morbidity, and the possibility of other options for later reconstruction. 8 As the first step in wound preparation before skin grafting, combination therapy served as a scaffold to increase intrawound perfusion, accelerate granulation tissue formation, and reduce edema and bioburden. Therefore, it could be applied right after the hardware was exposed, so it was possible to perform the procedure immediately without time constraints compared with flap.…”

“…Several studies have shown good results for use in severe complex wounds accompanied by tendon or bone exposure. In addition, studies have shown better results when combined treatment with negative pressure wound therapy (NPWT) and artificial dermal substitutes is performed after extensive surgical debridement and management of NPWT 8,9 …”

“…In addition, studies have shown better results when combined treatment with negative pressure wound therapy (NPWT) and artificial dermal substitutes is performed after extensive surgical debridement and management of NPWT. 8,9 However, a serious soft tissue defect in a region such as the anteromedial surface of the leg or malleolus, not having a muscular bed and covered with only a thin layer of skin and subcutaneous fat, easily deteriorates to an intractable soft tissue defect. In particular, when these areas are accompanied by fractures and internal fixation using a plate is performed, soft tissue defects are likely to occur because of skin necrosis, and hardware is frequently exposed.…”