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32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck Region
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a
c
b
d
Fig. 32.5
wound after slipping on the ice and falling on a sharp
edge. (a) Nose after the initial injury. (b) Postoperative
appearance of the transected nares. (c) Cytal
wrapped around the nares repair and place covering the
dorsal nasal cartilage and bone. (d) Nasal stents wrapped
A 71-year-old female with a degloving nose
®
Burn Matrix
with Cytal
ring. (e) Two weeks postoperative. (f) Two months later.
Note the raised contracted scar healing of medial left brow
which did not have underlying Burn Matrix applied. (g)
The open nares
®
Burn Matrix to treat the internal nasal scar-
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B. A. Kraemer and A. G. Rowe
e
f
g
Fig. 32.5 (continued)
32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck Region
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a
b
c d
Fig. 32.6 A 75-year-old male needing closure of Mohs
surgical defect of his nasal tip after resection of a basal
cell skin cancer. (a) Initial patient appearance with forehead ap design outlined. (b) Use of the Cytal
Matrix as a lining of the undersurface of the forehead ap
pedicle. (c) Thin pliable forehead ap pedicle prior to ap
®
Burn
inset. (d) The transected pedicle demonstrating the healed
raw surface and minimal swelling and inammation of
the pedicle. (e) Appearance of patient at the time of inset.
(f, g) Twelve months later it healed without secondary
thinning or ap revision was required
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B. A. Kraemer and A. G. Rowe
g
Fig. 32.6 (continued)
32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck Region
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a b
c d
381
Fig. 32.7 An 81-year-old male with left nasal sidewall
defect after Mohs surgical resection of a basal cell skin
cancer. Patient is on Coumadin and refuses ap reconstruction due to a prior stroke. (a) Initial appearance of
left nasal defect. (b) After placement of MicroMatrix
forehead ap pedicle with the UBM-ECM use.
This minimized distal ap swelling, so the patient
avoided a second-stage thinning procedure. In
addition, the device is primarily collagen, so the
device minimizes the exudate from the “raw surface” of the ap and makes the post-ap care
easier for these often-elderly patients.
powder on the wound. (c) Ten days later after alternate
day placement of the powder. At this point care changed to
alternate day placement of Cytal
weeks later. (e) After a composite ear skin-cartilage graft
®
performed under local anesthesia 6 months later
®
Wound Sheet. (d) Four
Serial placement of the MicroMatrix® powder
and then a single-layer wound sheet was used to
manage this large nasal sidewall defect to a
smaller size which was then amenable to a much
less complicated surgical procedure (Fig. 32.7).
This was one of the earlier-treated patients, and
we were using smaller amounts of the device
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B. A. Kraemer and A. G. Rowe
e
Fig. 32.7 (continued)
placed in the wound on alternate days. This patient
would not stop his Coumadin and was pleased
that he avoided a large procedure. He was content
to live with the cleft of his lateral nose (Fig.32.8)
but agreed to a nal repair as it could be done in
the ofce under local anesthesia. The UBM-ECM
lateral nasal wound healing readily supported the
free composite graft from the left ear.
32.4.3 Facial Soft Tissues
This is a case of a forehead abrasion/tissue loss
injury treated with a Cytal® Burn Matrix sheet
applied to provide sufcient UBM-ECM wound
device for the estimated several weeks it would
take for the wound to heal (Fig.32.8). While not
done in this case as it was used to treat acute
®
trauma, MicroMatrix
powder could possibly be
used under the sheet as there was a severe deep
tissue injury. The device was retained in the
wound with a Vaseline gauze sheet secured at the
margins of the wound bed. The typical pink
salmon-colored granulation tissue response is
noted. The healing which occurred in the most
heavily injured eyebrow region was sufcient for
subsequent micro-hair grafts which was critical
for the nal appearance. This patient returned
wanting treatment of his widened temple scar
with the wound device which was done resulting
in a minimally noticeable smooth scar.
This patient has subacute self-inicted bilateral cheek wounds compounded by infection
(Fig. 32.9). Both the MicroMatrix® powder and
Cytal® Burn Matrix were used in these semi- acute
wounds left undisturbed for several weeks under a
sutured Vaseline gauze dressing left undisturbed
for several weeks. This dressing also limited the
patient’s ability to further harm herself and permitted her to focus on the treatment of her psychiatric issues and not wound care. The right chin
wound at the time of operative treatment seemed
a more minor injury, so it wasn’t treated with the
wound device. In retrospect, using the UBMECM treatment on the chin wound might have
yielded a more favorable scar more like the much
deeper and larger upper cheek scars.
This case of an elderly man with a chronic radiated skin cancer resection wound shows that an
unfavorable wound bed, given enough time and a
UBM-ECM device, can heal (Fig. 32.10). This
was an earlier-treated patient, so only a singlelayer wound sheet which was folded over several
times was used. This was also one of our earlier
uses of more device placed for a prolonged time.
The simplied placement of a polyurethane sheet
dressing weekly was easily accomplished by the
patient.
a
b
32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck Region
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cd
Fig. 32.8 A 23-year-old male with forehead and eyebrow
wounds sustained after a windshield injury in a motor
vehicle accident. (a, b) Forehead, eyebrow, upper eyelid
lacerations, and tissue loss. (c) Cytal
applied to forehead and eyebrow wounds. (d) One week.
The brown- colored ECM needs more hydration for maximal activity. (e) Three weeks. Note the characteristic of
stimulated salmon-colored granulation tissue. (f)
ECMThree months post-injury. (g) 13 months later after microhair grafting of eyebrow. (h) Forehead and eyebrow
®
Burn Matrix ECM
appearance 27 months later. (i) Initial right temple wound
prior to debridement of necrotic ap. (j) Widened healed
right temple scar 27 months later. Patient desires improvement. (k) Excision of temple scar. (l) Mobility of skin
edge closure. (m) Placement of Cytal
wound bed with deep dermal sutures imbricating the
wound device up into the dermal closure. (n) Subcuticular
Prolene suture closure with outer skin glue placement. (o)
Healed wound appearance 6 weeks later after sutures
removed
®
Burn Matrix into
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B. A. Kraemer and A. G. Rowe
ef
Fig. 32.8 (continued)
32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck Region
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ij
385
Fig. 32.8 (continued)
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B. A. Kraemer and A. G. Rowe
Fig. 32.8 (continued)
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