The use of OASIS Extracellular matrix in complex reconstruction of the lower leg after massive avulsion

Purpose
OASIS Extracellular Matrix (ECM) is a medical product that can be used for management of complicated wounds, including third-degree burns, many kind of ulcers (chronic vascular, diabetic, venous), and several other wound conditions where mechanical protection of underlaying tissue is needed. It's made from porcine small intestinal submucosa, providing a natural scaffold for cellular migration and wound healing. This matrix supports the formation of granulation tissue and is involved in angiogenesis, which are critical steps in the wound healing process (1).

Methods and materials
In the course of this case report, patient data were used from the Department of plastic and reconstructive surgery, University Hospital Center Rijeka, Croatia. A 30-year-old male, a motorcyclist, with a previous history of type I Diabetes Mellitus, sustained multiple traumatic injuries including a compound fracture of the tibia and fibula with extensive soft tissue damage, an avulsion fracture of the medial malleolus, and a traumatic open wound on the forearm with arterial involvement. After being treated by the traumatologist, the patient was transferred to the Plastic and reconstructive surgery department for further reconstructive treatment of residual defect. For the purpose of optimal treatment, reevaluation of the therapy for diabetes as well as hyperbaric oxygen therapy was conducted. Five days after admission, a necrectomy was preformed resulting in exposure of anterior border of the tibia that was deperiosted in whole exposed area. In purpose to close the defect, this procedure was followed by a reconstruction using an acellular dermal matrix. To complement the functional structure, a skin graft harvested from the left thigh, ensuring a comprehensive approach to wound closure. Postoperatively, the wounds were treated with a vacuum-assisted closure (VAC) system to encourage granulation tissue formation and to promote graft acceptance and wound healing.

Summary
Successful limb salvage was achieved with no postoperative complications, such as infection or rejection of grafts. The patient's wounds exhibited minimal granulation tissue, and there were no signs of chronic non-healing ulcers at the time of discharge. Finally, the patient underwent a tailored physiotherapy program early to maintain joint mobility and muscle strength.

Conclusions
Oasis ECM played a crucial role in promoting wound healing by providing a biocompatible scaffold that supports cell infiltration, tissue regeneration and ultimately, wound closure (2). The continued use and study of OASIS and similar products are likely to yield new insights into wound management, potentially revolutionizing the approach to treating complex wounds and enhancing the body's natural healing processes with aesthetically pleasant result superior to the ones achieved with free flaps. This aligns with the broader trend in healthcare towards more personalized and advanced treatment options, emphasizing the role of such technologies in shaping the future of medical care, saving costs and time.

References
1. Md Fadilah NI, Mohd Abdul Kader Jailani MS, Badrul Hisham MAI, Sunthar Raj N, Shamsuddin SA, Ng MH, Fauzi MB, Maarof M. Cell secretomes for wound healing and tissue regeneration: Next generation acellular based tissue engineered products. J Tissue Eng. 2022 Jul 28;13:20417314221114273. doi: 10.1177/20417314221114273. PMID: 35923177; PMCID: PMC9340325.
2. Somani AK. Application expansion of small intestinal submucosa extracellular matrix in complex and surgical wounds. J Wound Care. 2023 Jan 1;32(Sup1a):S20-S27. doi: 10.12968/jowc.2023.32.Sup1a.S20. PMID: 36744601.

Reconstructive

PSTM 2024