The Use of Acellular Urinary Bladder Matrix As Coverage for Fasciocutaneous Free Flap Donor Sites: An Alternative to Traditional Grafting Procedures

Background: Vascularized tissue reconstructions are a common modality for the repair of various defects of the head and neck. Although the potential for primary closure of the donor site is possible, the majority require grafting procedures to facilitate wound closure and epithelialization. Traditionally, split thickness and full thickness grafts are harvested to manage the exposed site. We propose an alternative modality that is already commonly used for complex wound coverage. The use of acellular urinary bladder matrix facilitates wound coverage at donor sites that is comparable to outcomes obtained through skin grafting.

Purpose: The purpose of this review is to: 1.) Evaluate our early experience with ACell as a dressing for the management of complex wounds subsequent to fasciocutaneous or osteocutaneous vascularized tissue harvests. 2.) Assess coverage of exposed tendons and duration for granulation and epithelial coverage 3.) Assess esthetic and functional outcomes compared to traditional means for the management of vascularized tissue harvest sites.

Methods: The study group consisted of 10 consecutive patients in which a significant cutaneous component was harvested, as part of a vascularized tissue reconstruction that did not permit primary closure.

Results: Functional and esthetic outcomes were comparable to traditional methods of donor site closure as determined by physical therapist evaluation and subjective assessment by the patient. In all subjects, no additional grafting was required to achieve full coverage. Irregularities of the wound achieved a level plane with granulation tissue on an average of 3 weeks after surgery, followed by an additional 4-7 weeks for epithelization. Wound care was minimal and included twice daily wet-to-dry dressings. It was noted that complete wound healing was delayed in the ACell group which required more attention during wound care when compared to published data. Advantages included facilitation of a robust granulation layer that levels wound irregularities and avoidance of an additional skin graft site.

Conclusion: The use of Acell urinary bladder matrix is a viable option for the rehabilitation of donor sites of vascularized tissue grafts that incorporate the skin. Benefits include the avoidance of an additional split or full thickness skin graft site, facilitation of epithelization, leveling of the donor site texture and an equivalent esthetic result compared with current practices for wound coverage.

References:

1.Parcells AL, Abernathie B, Ramazi D: The use of urinary bladder matrix in the treatment of complicated open wounds. Wounds 26(7):189-196, 2014

2.Kruper GJ, Vandegriend ZP, Lin HS, Zuliani GF: Salvage of failed local and regional flaps with porcine urinary bladder extracellular matrix aided tissue regeneration. Case Reports in Otolaryngology 2013:917183, 2013