Peroneus Brevis Muscle Flap with the use of INTEGRA® Wound Matrix and Split Thickness Skin Graft in the Treatment of Full Thickness Ulcerations: Case Reports and Technique Guide

Regenerative Surgery & Intra-Operative Protocols Utilizing Bone Marrow Aspirate Concentrate in Microsurgical & Limb Reconstruction

“…One major factor contributing to chronic non-healing ulcerations is the lack of an adequate wound base in which proliferation of the wound can occur. Furthermore, disruption of the soft tissue envelope, either by surgical or nonsurgical means, can leave little to no foundation to cover vital underlying structures [11]. One technique to attend to these wounds is the use of muscle flaps to cover and maintain a viable wound environment.…”

“…Application of cBMA, with its rich source of MSCs and Hematopoietic Stem Cells (HSCs), offers the ability for increased regeneration and infusion of these flaps into the transposed site [7]. Furthermore, the implementation of Platelet Rich Plasma (PRP) releases various growth factors that are vital for the regeneration of a healthy wound base post muscle flap [11]. A logical speculation is that the bone marrow-derived stem cells and growth factors within the cBMA and PRP are useful in the prevention of muscle necrosis [10].…”

“…This process begins with the application of a regenerative dermal matrix, such as the INTEGRA Bilayer Mesh Graft (Integra LifeSciences Corp). This decreases the time it takes to grow a dermal matrix, and restores the form and function of the graft site [11]. Furthermore, this creates a vascularized layer to aid in application of a skin graft.…”

“…The silastic layer of the graft aids in covering the wound to protect it from the outside environment as well. Application of Negative Pressure Wound Therapy (NPWT) at this time decreases the risk of hematoma/seroma, which increases the chance of take of the muscle [11].…”

Reverse Distally Based Abductor Hallucis Muscle Flap for Soft Tissue Coverage of the First Metatarsophalangeal Joint Wounds

“…Muscle flaps remain often first choice when dealing with bone infections associated with osteomyelitis, soft tissue infections, and large cavities. 1 Because common local distally based muscle transpositional flaps have difficulty reaching the forefoot plantar region, these defects are normally treated by free tissue transfer. 2 However, free flap procedures are relatively complex, time consuming, requires microsurgical expertise, and has donor-site morbidity, which may not be suitable to candidates who are high risk for long operating times and extensive anesthesia risk.…”