Serial Application of Meshed Collagen-chondroitin Silicone Bilayer Matrix to Obtain Full Coverage over Bone and Tendon in Challenging Situations and Medically Compromised Patients: A Small Case Series

Abstract

Introduction. Soft tissue defects in medically compromised patients present significant challenges to the reconstructive surgeon, particularly when vital structures are exposed. This case series reports clinical outcomes of 5 adult patients with challenging medical problems whose wounds were managed using a meshed collagen-chondroitin silicone bilayer matrix to obtain coverage over bone and tendon. Materials and Methods. Patient 1 had significant degloving of the scalp. Patient 2, who had a giant neglected tumor, had a defect comprising the entire occipital skull. Patients 3 and 4 had necrotizing infection in a lower extremity open wound and a pretibial wound (patient 3). Patient 5 sustained a severe crush injury of his forearm and had a large open wound. All the wounds had exposed structures. Results. The incorporation rate of the dermal matrix in the wound bed was 100% in patients 1 and 5, 75% in patient 2, and 90% in patients 3 and 4. Patients 2 and 4 received a second application of dermal matrix to obtain full coverage of the wounds. Each patient achieved stable soft tissue coverage and successful reconstruction. Conclusions. These 5 cases highlight the capacity and capability of this dermal matrix to allow coverage over exposed bone and tendon, as well as the clinical utility of the serial application of this matrix.