Abstract
Introduction
Esterified hyaluronic acid matrix (eHAM) skin substitutes have been applied to burn wounds, chronic wounds, and even congenital syndactyly release. eHAM consists of a controlled release form of hyaluronic acid (HA) in a matrix covered with a silicone layer. HA draws water into the wound bed, allowing for capillary ingrowth and cellular invasion. Angiogenesis and dermal regeneration with endothelial cells and fibroblasts promotes tissue regeneration.
Methods
We performed a retrospective review of patients treated with an eHAM at the regional burn center in the past year. A total of fifteen patients were identified. Their charts were reviewed to assess demographics, time to graft, follow-up duration, mechanism, comorbidities, outcomes, and complications. Additionally, photographic images were obtained from the burn center camera for each patient to assess clinical progression of healing.
Results
The mean patient age was 45.8 years. Mean time to split-thickness skin graft was 22.9 days, with a range of 14 to 36 days. The medium follow-up for this study was 12 weeks. Six patients sustained an injury due to either a thermal or electrical burn, and seven patients had diabetes mellitus. Nine patients were active smokers. Eight patients had hypertension and four had kidney disease. Coverage included tibia, calcaneus, Achilles tendon, and dorsal foot extensor tendons. One patient received bedside application of HM. One patient received a second OR application of HM. This series consisted of fifteen patients with multiple medical comorbidities and exposed critical structures, thirteen of which were successfully treated with eHAM.
Conclusions
When critical structures such as bone and tendon are exposed, dermal coverage is often needed prior to skin-grafting. Dermal coverage is necessary to prevent infection, desiccation, and osteomyelitis. eHAM is a modality that create a granulation bed that covers critical structures, allowing for subsequent skin-grafting in a properly selected and challenging population.
eHAM can be used as a dermal substitute in complex wound cases as a bridge to definitive coverage with autologous skin-grafting. This study has demonstrated successful coverage of tendons, bones, and chronic wounds in mean time of three to four weeks in a population with multiple medical comorbidities, complex lower extremity wounds, and contraindications to local and free flap coverage.
Applicability of Research to Practice
This research is based on clinical practice. We have salvaged thirteen of fifteen wounds that were at risk for amputation or further delayed healing, desiccation, and infection.
Use of Flap Salvage for Lower Extremity Chronic Wounds Occurs Most Often in Competitive Hospital Markets
