Utility of Porcine-Derived Xenograft as an Adjunct to Split-Thickness Skin Grafting in Lower-Extremity Wounds

Abstract

Objective Porcine-derived xenograft biological dressings (PXBDs) are occasionally used to prepare chronic wound beds for definitive closure before split-thickness skin grafts (STSGs). We sought to determine whether PXBD influences rate of STSG take in lower-extremity wounds. Methods Lower-extremity wounds treated with STSGs were retrospectively reviewed. Patients were included in one of two groups: wound bed preparation with PXBD before STSG or no preparation. Patients were excluded if they received wound bed preparation via another method. Patient demographics, comorbidities, wound history, wound bed preparation, and 30- and 60-day outcomes were collected. Results There was no difference in healing outcomes between the PXBD (n = 27) and no preparation (n = 39) groups. At 30- and 60-day follow-up, percentage of STSG take was not significantly different between groups (77.9% versus 79.0%, P30 = .818; 82.2% versus 80.9%, P60 = .422). Mean wound sizes at these follow-up periods were not different (4.4 cm2 versus 5.1 cm2, P30 = .902; 1.2 cm2 versus 1.1 cm2, P60 = .689). The PXBD group had a higher mean ± SD hemoglobin A1c level (8.3 ± 3.5 versus 6.9 ± 1.6; P = .074) and age (64.9 ± 12.8 years versus 56.3 ± 11.9 years; P = .007) versus the no preparation group. Conclusions Application of PXBDs for wound bed preparation had no effect on wound healing compared with no wound bed preparation. The two groups varied only by mean age and hemoglobin A1c level. The PXBD may be beneficial, but these results call for randomized controlled trials to determine the true impact of PXBDs on wound healing. In addition, PXBDs may have utility outside of clinically oriented outcomes, and future work should address patient-reported outcomes and pain scores with this adjunct.

Skin substitutes as treatment for chronic wounds: current and future directions

“…CHSA decreases pain, stimulates angiogenesis, prepares the wound bed for autografting, controls infection, and is low cost but confers the risk of disease transmission ( 123 ). Xenografts such as fish skin grafts promote efficient wound healing, but potential of rejection must be considered ( 90 , 93 , 94 ). Lastly, tissue engineered skin substitutes such as BLCC and DRT promote healing but provide the challenge of cost ( 97 , 124 , 125 , 129 , 131 , 132 , 157 ).…”

“…However, xenografts confer the advantages of being lower cost, in unlimited supply, and having lower risk of disease transmission than their allograft counterparts (92). Xenografts used in the treatment of chronic wounds include porcine, bovine, and more recently, fish (94,95). A major advantage of the use of fish skin grafts over other types of xenografts include lower risk of viral transmission, enabling mild processing that preserves skin integrity which contains beneficial collagen, elastin, and Omega-3 polyunsaturated fatty acids thought to improve reepithelialization and microbial defense (93,96,97).…”

Experience of Wound Bed Preparation with Different Methods

“…Porcine xenograft has been used for wound bed preparation with the hope of improving the take of skin autograft over burn and nonburn wounds [3,4]. A recently published article [5] compared the use of porcine xenografts with no specific method for wound bed preparation and concluded that there was no difference in these two methods in terms of wound closure. But the author's experience differs from this study.…”