Use of Collagen Extracellular Matrix Dressing and NPWT to Heal Complex Pediatric Wounds

Chronic non-healing wounds represent a challenge as they do not follow “expected” sequential physiologic process of healing. Instead, “stalling "occurs, usually in inflammation phase. Stalling may result from inability to recruit necessary cells, lack of “ building materials”, bacterial presence, resulting in biofilm or cellular dysfunction secondary to medication. While TIME principles of standard wound care are applicable to all wounds, recognition of the contributing factors may gauge treatment.

Pediatric wounds healing can be delayed due to congenital disorders, co-morbid illness, infections, medications, oncology interventions, and product incompatibility with pediatric skin. Treatment of pediatric non-healing wounds with acellular dermal template* and NPWT is demonstrated via 3 cases. 12 yo with multiple comorbidities, including obesity, chronic steroids use for panhypopituitarism, hypothyroidism, MRCP, admitted for respiratory failure. She developed 2 non-healing surgical wounds from chest tubes. 16 yo with dehisced, infected metaport wound. His co-morbidies were recurring adenocarcinoma of cecum, chemotherapy, NSAIDs, and low cell counts. Both patients likely had degraded ECM, overabundance of MMPs and poor regeneration capability.3^rd patient is 7month old with non-healing surgical cardiac incision. All patients had TIME principles applied to wounds for a period of time, but closure was not obtained prior to dermal template use.

Dermal template used is a proprietary extracellular matrix (ECM) material that retains high levels of innate biologic macromolecules, which promote cell proliferation and vascular ingrowth. It contains 90% native, intact collagen and 10% ECM. Template is designed to retain the ECM’s structural proteins collagen I and III, elastin, adhesive proteins laminin, fibronectin, and collagen IV, FGF2 and glycosaminoglycans.  This supplements patient’s degraded ECM, reduces MMPs and regulates intercellular communication. The structural architecture allows cell migration, proliferation, and differentiation, allowing the deposition of new matrix and supporting tissue regeneration.

We successfully closed all wounds, illustrating application of collagen/ECM template in pediatric population.