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Utilizing matrix allograft to cover open wounds without skin graft or flap coverage
Daniel Yang Hong, MD, Peter C Noback, MD, Liana J Tedesco, MD and R. Kumar Kadiyala, MD, PHD, Columbia University Medical Center, New York, NY

Introduction:
A long standing challenge in damage-control orthopedics is soft tissue coverage for defects caused by traumatic injuries. While modern advances in flap creation have bypassed conventional solutions like amputation, there is still a plethora of challenges associated with grafting. Skin grafts, in particular, require tedious fixation and violation of the patient's donor area. Allograft has been shown to successfully cover wounds economically and efficiently. We seek to share our clinical outcomes in treating patients who have sustained open wounds with a collagen-glycosaminoglycan matrix allograft.

Methods:
Retrospective chart review was performed; de-identified patient data was collected. Patients with allograft used to cover fasciotomy sites, donor sites from flap coverage, or distal radius fixation sites deemed too swollen to primarily close were included. Exclusion criteria were pediatric patients and those without post-operative follow-up.

Results:
7 patients were identified. The median age of the patients was 63 years; 3 were female and 4 were male. Median follow-up time was 3 months. A total of 7 forearms and 2 tibias were covered with allograft in the operating room; these wounds ranged from 6 to 60 square centimeters. By final follow-up, all patients were noted to have satisfactory wound healing without need for subsequent skin grafting or flap coverage.

Conclusions:
Traumatic open injuries have high morbidity and mortality; soft tissue coverage is often a challenge facing hand surgeons once the initial injury is stabilized and fixed. Biodegradable matrix allograft is a reasonable first option for providing a biologic scaffold to cover small to medium open wounds. In this study, we were able to demonstrate the ability to provide definitive coverage of these wounds without the need for skin graft or reconstructive flap procedures.


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