Abstract
Background
Extracellular matrix is used in various applications. We present our preliminary experience using a new device that consists of a porcine extracellular matrix with an epithelial basement membrane (MatriStem®, ACell, Inc. Columbia, MD, USA) for adolescent pilonidal disease.
Methods
A retrospective review of four patients with pilonidal disease was undertaken. Three occurred in the gluteal cleft, and the fourth in the umbilicus. In the first patient, the wound deficit was filled with lyophilized MicroMatrix powder and a sheet of Multilayer Wound Matrix was placed to cover the wound. In the second patient, two sinus tracts were debrided, packed with MicroMatrix, and a sheet of fenestrated Burn Matrix was applied. In the third patient, MicroMatrix and Surgical Matrix PSMX (six-layer) was applied as a roll filling the dead space. In the last patient, an umbilical sinus 3 cm deep was packed with MicroMatrix powder followed by a rolled sheet of 2-ply Surgical Matrix RS. Patients were evaluated weekly post-operatively, and more MicroMatrix and sheet material was added if a wound deficit was still present. Measurements were taken in two dimensions, diameter and depth, to characterize wounds.
Results
Resolution of wound deficit was graphed versus time. Pain was assessed by scoring 0–10. Rapid wound closure was achieved. Two of the patients had failed wound healing with saline dressing changes prior to MatriStem application. These two patients in particular were highly satisfied with the comfort of the MatriStem approach relative to their time with saline dressings. Most had no pain after 1 week when bolster sutures were removed.
Conclusion
In the treatment of open pilonidal wounds in adolescents, porcine urinary bladder matrix wound care devices offer closure times and cost similar to well-established methods while offering a substantial advantage in terms of patient comfort and convenience. This preliminary experience supports a prospective study.
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References
Al-Khamis A, McCallum I, King PM, Bruce J (2010) Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database System Rev (1):Cd006213. doi:10.1002/14651858.CD006213.pub3
Baharestani M, Amjad I, Bookout K, Fleck T, Gabriel A, Kaufman D, McCord SS, Moores DC, Olutoye OO, Salazar JD, Song DH, Teich S, Gupta S (2009) V.A.C. Therapy in the management of paediatric wounds: clinical review and experience. Int Wound J 6(Suppl 1):1–26
Fike FB, Mortellaro VE, Juang D, Ostlie DJ, St Peter SD (2011) Experience with pilonidal disease in children. J Surg Res 170(1):165–168. doi:10.1016/j.jss.2011.02.016
McCallum IJ, King PM, Bruce J (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336(7649):868–871
Shankaran V, Brooks M, Mostow E (2013) Advanced therapies for chronic wounds: nPWT, engineered skin, growth factors, extracellular matrices. Dermatol Ther 26(3):215–221
Rommer EA, Peric M, Wong A (2013) Urinary bladder matrix for the treatment of recalcitrant nonhealing radiation wounds. Adv Skin Wound Care 26(10):450–455
Kimmel H, Rahn M, Gilbert TW (2010) The clinical effectiveness in wound healing with extracellular matrix derived from porcine urinary bladder matrix: a case series on severe chronic wounds. J Am Coll Cert Wound Special 2(3):55–59. doi:10.1016/j.jcws.2010.11.002
Nieponice A, Ciotola FF, Nachman F, Jobe BA, Hoppo T, Londono R, Badylak S, Badaloni AE (2014) Patch esophagoplasty: esophageal reconstruction using biologic scaffolds. Ann Thorac Surg 97(1):283–288. doi:10.1016/j.athoracsur.2013.08.011
Sasse KC, Brandt J, Lim DC, Ackerman E (2013) Accelerated healing of complex open pilonidal wounds using MatriStem extracellular matrix xenograft: nine cases. J Surg Case Rep. doi:10.1093/jscr/rjt025
Stewart AM, Baker JD, Elliott D (2011) The effects of a sacrococcygeal pilonidal sinus wound on activities of living: thematic analysis of participant interviews. J Clin Nurs 20(21–22):3174–3182
Stewart AM, Baker JD, Elliott D (2012) The psychological wellbeing of patients following excision of a pilonidal sinus. J Wound Care 21(12):595–596, 598–600
Gaiser MR, Lee SB, Enk A, Schrott P, Weisser H (2013) Surgical intervention of pilonidal sinus: impact on patients’ postoperative satisfaction and return to work time. Euro J Dermatol 23(4):487–490
Nasr A, Ein SH (2011) A pediatric surgeon’s 35-year experience with pilonidal disease in a Canadian children’s hospital. Can J Surg 54(1):39–42
Caniano DA, Ruth B, Teich S (2005) Wound management with vacuum-assisted closure: experience in 51 pediatric patients. J Pediatr Surg 40(1):128–132. doi:10.1016/j.jpedsurg.2004.09.016
Biter LU, Beck GM, Mannaerts GH, Stok MM, van der Ham AC, Grotenhuis BA (2014) The use of negative-pressure wound therapy in pilonidal sinus disease: a randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision. Dis Colon Rectum 57(12):1406–1411. doi:10.1097/DCR.0000000000000240
Sasse KC, Ackerman EM, Brandt JR (2013) Complex wounds treated with MatriStem xenograft material: case series and cost analysis. OA Surg 1(1):3
Lecheminant J, Field C (2012) Porcine urinary bladder matrix: a retrospective study and establishment of protocol. J Wound Care 21(10):476–482
Brown BN, Londono R, Tottey S, Zhang L, Kukla KA, Wolf MT, Daly KA, Reing JE, Badylak SF (2012) Macrophage phenotype as a predictor of constructive remodeling following the implantation of biologically derived surgical mesh materials. Acta Biomater 8(3):978–987
Gilbert TW, Stewart-Akers AM, Badylak SF (2007) A quantitative method for evaluating the degradation of biologic scaffold materials. Biomaterials 28(2):147–150
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Dorman, R.M., Bass, K.D. Novel use of porcine urinary bladder matrix for pediatric pilonidal wound care: preliminary experience. Pediatr Surg Int 32, 997–1002 (2016). https://doi.org/10.1007/s00383-016-3915-0
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DOI: https://doi.org/10.1007/s00383-016-3915-0