Use of an Acellular Flowable Dermal Replacement Scaffold on Lower Extremity Sinus Tract Wounds

Abstract

A novel injectable human dermal matrix has been developed for the treatment of complex diabetic sinus tract wounds. Bioengineered grafts are commercially available that have been somewhat effective in treating chronic wounds such as diabetic foot ulcers; however, these bioengineered grafts are only available in sheet form. These therapies are less effective in treating complex or irregularly shaped wounds that demonstrate tunnels or extensions into deep soft tissue. One acellular graft (GRAFTJACKET, Matrix, Wright Medical Technology, Arlington, Tennessee) that has been shown to effectively treat open wounds is also available in a micronized form (GRAFTJACKET Xpress Scaffold, Wright Medical Technology). This human dermal graft forms a flowable soft tissue scaffold that can be delivered via syringe into tunneling wounds. In this retrospective series, 12 patients with deep tunneling wounds were treated with GRAFTJACKET Xpress Scaffold and followed for 12 weeks. Complete wound healing was achieved in 10 of 12 patients within the 12-week evaluation. The average time to complete healing was 8.5 weeks, whereas the average time to depth healing was 7.8 weeks. The data from the study suggest that this injectable human dermal matrix has unique properties that allow it to facilitate healing of complex tunneling diabetic foot ulcers. The material is easy to prepare and inject into the wound, thereby preventing the necessity of extensive surgical exposure. The matrix supports neo-subcutaneous tissue formation and allows the body to rapidly repair these wounds.

Human acellular dermal wound matrix: evidence and experience

“…Complete wound healing (100% epithelialisation without drainage) was the primary endpoint for two RCTs, while the third RCT evaluated wound size reduction at 4 weeks as the primary endpoint. Results from a small retrospective study also demonstrate the effectiveness of FSTS to treat complex tunneling DFUs and chronic ulcers.…”

The Role of Acellular Flowable Matrix in Tissue Regeneration

“…Cellular and acellular bioengineered grafts have demonstrated some promise as alternatives for the treatment of such wounds. [14,15,16,17] However, these grafts are provided as sheets in planar form. As such, they are harder to use and less effective in sinus tract wounds because of the irregularly shaped tunnels or extensions in these wounds.…”

“…Ideally, the matrix material is capable of conforming to the wound area and providing the necessary bulk and scaffold to support the woundhealing process. [17] An injectable form of an acellular human dermal regenerative tissue matrix Graftjacket® Xpress Flowable Soft Tissue Scaffold was designed to treat difficult tunneling wounds in a minimally invasive manner. This injectable matrix is a micronized form of a human acellular dermal regenerative tissue matrix.…”

“…These properties result in the rapid revascularization and cellular repopulation of the matrix scaffold. [17] Graftjacket® Xpress FSTS supports the body's repair of damaged or inadequate integumental tissue, such as deep dermal wounds or diabetic ulcers. Graftjacket® FSTS is supplied as a dried, acellular dermal particulate in a syringe, before aplication it is reconstituted through syringe adapter with sterile saline solution and applied directly into the debrided, clean wound through a flexible applicator tip.…”

“…The matrix supports neo-subcutaneous tissue formation and allows the body to rapidly repair these wounds. [17] We treated two patients with lower limb chronic wounds of different etiology: unhealed ulcer off the stump following transmetatarsal amputation of the foot in a patient with diabetes and a patient with foot ulcer after traumatic foot amputation. Both patients were previously treated for two years with modern wound dressings, that were changed according to the appearance of the bottom of the wound and the amount of exudate.…”