(CS-030) Urinary Bladder Matrix Devices Support Closure in Necrotizing Fasciitis Wounds

Hannah Baker, PhD

Introduction: Necrotizing fasciitis and the subsequent wounds in aggressive scenarios present a multidisciplinary challenge and often merit an advanced management approach. In particular, the wounds resulting from surgical management of these wounds may be complicated by irregular geometries and involvement of multiple tissue layers including exposed avascular structures.

Skin substitutes amenable to irregular wound beds and use over exposed avascular structures such as tendon or bone may support wound closure for complicated wounds associated with necrotizing fasciitis. Porcine derived urinary bladder matrix (UBM) particulate and sheets have been studied for use in a variety of complex wounds. UBM devices have been found to be associated with a pro-remodeling host immune response in support of wound closure1-3. The powder and sheet devices offer a tunable approach for complicated wound geometries and may be used in wounds with exposed avascular structures.

Methods: We have retrospectively assessed n=3 cases wherein UBM devices were utilized for management of wounds resulting from necrotizing fasciitis in surgical patients in our practice. These patients were further complicated by comorbidities, tunneling aspects of the wound, and/or exposed avascular structures. Management entailed thorough debridement coupled with serial applications of UBM devices. UBM particulate and sheets were utilized, and the particulate was mixed with saline to create a paste for use in tunneling aspects of wounds when necessary.

Results: All wounds progressed toward closure with diminished wound area and depth over time and with evidence of new tissue deposition.

Discussion: In these cases, UBM devices supported successful management of wounds associated with necrotizing fasciitis. Use of the devices was associated with new tissue deposition and progression toward closure. The outcomes in this series highlight the utility of UBM particulate and sheets for use in complex wound geometries including uneven surfaces, tunneling and undermining, and over exposed avascular structures.