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Purpose: Application of urinary bladder matrix (UBM), for wound repair has been reported in adult patients with complex wounds. The first of such a therapy, to our knowledge, presented in a pediatric patient who developed a full thickness leg wound due to central venous line (CVL) infiltration from caustic agents.
Case Review: A 3 month old female, with double outlet right ventricle repair developed thrombosis throughout her Glenn anatomy. A left femoral CVL was placed for infusion of heparin. On post-op day 3, her leg became discolored. The left leg wound progressed to a full thickness wound 6 cm x 6 cm, prompting plastic surgery consult. Recommendation was debridement with cadaveric allografting followed by autografting. The cadaveric graft failed and autografting was recommended. Due to her thrombosis risk, discontinuation of her anticoagulation for the time necessary to prevent bleeding for autografting was high. Alternatives to surgery were investigated and the use of porcine-derived UBM risk was low. The matrix was applied with vaseline gauze and hydrogel. Applications over two months resulted in epithelial growth.
Discussion: Matristem UBM is an extracellular matrix (ECM) that has been used in complex wounds. Such wounds are difficult to heal due to inflammatory mediators that can destroy native ECM, which helps in wound repair. The UBM supports progenitor cell proliferation while promoting angiogenesis for epithelial closure. Therefore, MatriStem holds advantages in the treatment of critically ill patients through preventing a need for surgical interventions. In maintaining natural biologic ECM, UBM promotes epithelial growth with less scarring. The pigmentation is expected to return to normal within a year. The team has used this product for other wounds in pediatric critically ill patients with good results. Further research in the use of this product for complex wounds in pediatric patients is warranted.