Extracellular matrix graft for the surgical management of Hurley stage III hidradenitis suppurativa: a pilot case series

Abstract

Objective: Surgical management of Hurley stage III hidradenitis suppurativa (HS) typically involves the excision of diseased tissue and subsequent reconstruction, potentially leading to complications or recurrence of the disease. This pilot case series sought to evaluate a decellularised ovine forestomach matrix (OFM) extracellular matrix (ECM) graft for soft tissue regeneration as part of surgical reconstruction of stage III HS of the axilla. Method: The prospective pilot case series involved six participants and a total of eight defects. The ECM graft was used either as a dermal substitute for a staged reconstruction (n=3 defects) or as an implant under a fasciocutaneous flap (n=5 defects) following wide excision of the diseased tissue. Results: In all cases complete healing was achieved, with no major surgical complications. When used as a dermal substitute the OFM graft was completely granulated within 2–4 weeks, with defects closing by secondary intention or following placement of a split-thickness skin graft. When used as an implant beneath a fasciocutaneous flap, healing of the surgical sites was observed after 1–3 months. At the long-term follow-up (3–12 months), all participants had excellent range of motion and none had reported disease recurrences. Conclusion: This pilot case series explored the implementation of an ECM graft as part of the surgical management of axilla Hurley stage III HS. Although the study had a limited number of participants, long-term outcomes were promising and suggest further studies are warranted.

Co-Graft of Acellular Dermal Matrix and Split Thickness Skin Graft—A New Reconstructive Surgical Method in the Treatment of Hidradenitis Suppurativa

“…In one case, 22 weeks after ADM application, STSG was used. However, Chaffin et al’s method did not present an ADM and STSG co-graft [ 48 ].…”

Wound care in hidradenitis suppurativa

“…For more extensive areas of hidradenitis that have been surgically excised in the operating room, the use of negative pressure wound therapy and extracellular matrix grafts has been described. Extracellular matrix grafts are dermal substitutes that promote wound healing by stimulating angiogenesis and recruiting mesenchymal stem cells 27 . The beneficial use of an extracellular matrix graft composed of decellularized ovine forestomach matrix has been described for Hurley Stage III axillary cases closed by secondary intention or split‐thickness skin graft 27 .…”

“…Extracellular matrix grafts are dermal substitutes that promote wound healing by stimulating angiogenesis and recruiting mesenchymal stem cells 27 . The beneficial use of an extracellular matrix graft composed of decellularized ovine forestomach matrix has been described for Hurley Stage III axillary cases closed by secondary intention or split‐thickness skin graft 27 . Negative pressure wound therapy utilizes a vacuum‐type system overlying the wound to promote granulation tissue formation and angiogenesis and to also secure skin grafts or flaps from shearing forces.…”

“…27 The beneficial use of an extracellular matrix graft composed of decellularized ovine forestomach matrix has been described for Hurley Stage III axillary cases closed by secondary intention or splitthickness skin graft. 27 Negative pressure wound therapy utilizes a vacuum-type system overlying the wound to promote granulation tissue formation and angiogenesis and to also secure skin grafts or flaps from shearing forces. It has been used after hidradenitis surgery resulting in large defects in the axillary, buttock, and groin regions with success.…”

Further structural characterization of ovine forestomach matrix and multi-layered extracellular matrix composites for soft tissue repair

“…5,[7][8][9] OFM has been used as 1 Department of Research and Clinical Development, Aroa Biosurgery Limited, Auckland, New Zealand 2 a universal building block for the design of devices for soft tissue repair, either as single layers of dECM (∼200 μm thick), powders or multi-layered devices (up to ∼3 mm thick) 10,11 ; and as a platform for further functionalization such as antimicrobial dECM devices. 12 OFM-based devices have been adopted into regular clinical practice for the treatment of acute and chronic wounds, [13][14][15][16][17] reconstructive surgery [18][19][20][21] and abdominal wall repair. 22,23 Xenograft-derived dECM for human soft tissue repair have been utilized for decades.…”