Healing recalcitrant pressure related wounds on paraplegic and quadriplegic individuals

Problem: Wheelchair bound paraplegic and quadriplegic individuals are at risk to become pressure ulcer patients repeatedly in their torso areas. Once the injury(s) have occurred healing often involves scare tissue as a result, which does not have the tensile strength of the original tissue. Repetitive injury can occur with healing becoming more difficult due to reduced muscle mass, adipose cushion and collateral circulation. Negative Pressure Wound Therapy, complicated flaps and grafts have all been used to heal chronic pressure ulcers of the type described.

Discussion: It has been shown that the use of extra cellular matrix as a scaffold for tissue reconstruction induces tissue remodeling rather than scar tissue formation. The use of Urinary Bladder Material (UBM) based Extracellular Matrix (ECM) may assist with the improved tissue rebuilding, healing time and ultimate tensile strength.

Case description:  Three patients, two with quadriplegia and one with paraplegia were admitted with complicated wounds: A failed flap with dehiscence in the R ischium; A coccygeal stage IV wound over one year old failed at NPWT; and full sacral/coccygeal/scrotal stages varying from II to IV multiple wounds (average wound ages 6 months – 4 years) All wounds were debrided, and managed with a UBM fenestrated sheet of two to three applications. A Contact layer was placed over the wound for 48 hours. Dressing changes then included use of gentle cleansing, contact layer and absorbent dressing daily. Healthy epithelial tissue was significant within 14 days on all three patients. Healing was observed following treatments for two to four week’s while in-patient.

Conclusion: The use of UBM based ECM may be advantageous in the treatment of serious pressure related torso injuries in Paraplegics and Quadriplegics. Further study of resultant tensile tissue strength contributing to prevention of reoccurrence is a potential future study.