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32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck Region

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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

Fig. 32.5 (continued)

32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck Region

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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 inammation 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

Fig. 32.6 (continued)

32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck 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

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 ofce 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 sufcient 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 sufcient 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-inicted 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 simplied placement of a polyurethane sheet dressing weekly was easily accomplished by the patient.

32 Use ofPorcine Urinary Bladder Matrix (UBM-ECM) intheHead andNeck Region

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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