Porcine Urinary Bladder Extracellular Matrix for Treatment of Periocular Skin Defects

Abstract

Purpose: To describe the experience of 4 oculoplastic surgeons with porcine bladder matrix for periocular anterior lamella and donor site skin defects either as stand-alone treatment or in conjunction with other reconstructive procedures. The authors hypothesized that defect size and location influence the requirement for additional matrix treatments or ancillary procedures. Methods: Following the Institutional Review Board approval, the authors conducted a retrospective review of 17 patients treated with porcine bladder matrix at 2 oculoplastic practices between 2016 and 2018. Powdered matrix was applied to the skin defect and overlaid with a matrix sheet. Subsequent rounds of matrix treatment or other reconstructive procedures were performed as necessary. Defect size and location were correlated to the number of ancillary matrix treatments or surgical procedures via univariate analysis. Results: Twenty-five sites (21 primary and 4 donor) in 17 individuals (8–95 years, M = 58.8 years, 10 males) were treated with porcine bladder matrix. All wounds healed successfully. Additional matrix treatments were administered at 5 sites. Ancillary procedures were performed for 7 sites. Upper lid involvement and larger defect size tended to require additional ancillary procedures (p = 0.006), while lower eyelid and other periocular defects required fewer procedures (p < 0.001). Conclusion: Porcine bladder matrices are useful adjuncts to healing periocular anterior lamella defects in various settings. Such repairs are useful in nonsurgical candidates, but must take into account varying levels of complexity based on lesion location. Smaller defects are more conducive to application of matrices as stand-alone treatment, while larger or upper eyelid defects often require additional procedures.

Use of Porcine Urinary Bladder Matrix in Socket Reconstruction After Pediatric Orbital Exenteration

“…Engineered acellular dermal matrix grafts have been successfully utilized in various settings, including traumatic, postsurgical, and chronic wounds. 3–5 The use of an artificial dermal matrix is minimally invasive compared to other reconstruction options and decreases anesthesia time, postoperative monitoring, and wound care. It is beneficial for patients who are not ideal candidates for flaps or have limited healthy donor graft sites.…”

“…It is beneficial for patients who are not ideal candidates for flaps or have limited healthy donor graft sites. 5,10 Specifically, porcine UBM has proven to be useful in various periocular skin defects such as prior Mohs surgery, trauma, necrotizing fasciitis, graft sites, skin graft necrosis, and epidermolysis bulosa, both independently and in conjunction with ancillary procedures. 5…”

“…Recently, engineered acellular dermal grafts have been used in various settings with increasing popularity due to their minimally invasive nature and rapid healing time. 3–5 One such engineered graft is a porcine urinary bladder matrix (UBM) (ACell Cytal Columbia, MD, U.S.A.), which is derived from the porcine urinary bladder and comprises lamina propria and epithelial basement membrane. 3 In contrast to other dermal products, the porcine UBM is not crosslinked, theoretically allowing for more effective vascularization and cellularization.…”

The Three-Dimensional Structure of Porcine Bladder Scaffolds Alters the Biology of Murine Diabetic Wound Healing

“…A recent small oculoplastic case series on periocular anterior lamella and donor site defects, for example, used a combination of porcine urinary bladder matrix (UBM)-derived ECM sheets and particulate to show successful wound healing, but the mechanisms for this are poorly understood. 16,17 There is a notable gap in the literature regarding the effects of scaffolds in different 3D structures on skin wound healing, as well as the combined efficacy of such regimens. In this study, the investigators attempt to fill this knowledge gap by assessing the efficacy of a porcine-derived urinary bladder particulate matrix, used alone or in combination with sheet scaffolds, in diabetic wound healing.…”

“…Further, the efficacy of coapplying biomaterials in differing material phases remains poorly understood and is ripe for investigation. A recent small oculoplastic case series on periocular anterior lamella and donor site defects, for example, used a combination of porcine urinary bladder matrix (UBM)-derived ECM sheets and particulate to show successful wound healing, but the mechanisms for this are poorly understood 16,17 …”