Extracellular Wound Matrix (OASIS®): Exploring the Contraindications. Results of Its Use in 32 Consecutive Outpatient Clinic
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Wound healing occurs in 3 overlapping phases: the inflammatory phase (“lag phase”), the proliferative phase (tissue formation), and the remodeling phase. In the proliferative phase, aside from angiogenesis, granulation tissue is formed and the wound is re-epithelialized.1 In the authors’ wound clinic, re-epithelialization after successful debridement and granulation is sometimes the most difficult part of the wound closureprocess. Sometimes the wounds are very large and are preferably closed by split-thickness skin grafting. However, most of the clinic patients have high anesthetic risks. In the present study, 64.5% of the treated patients are of American Society of Anesthesiologists (ASA) class III/IV, in whom admittance to the hospital and subsequent surgery might not only lead to a high morbidity, but also possible death.2 Therefore, there is a constant search for wound treatments that will lead to full epithelialization of wounds without the need for anesthesia. Other important factors are that the method should be painless and the treatment should preferably be performed on an outpatient basis.
Extracellular matrix (ECM) products seem to be a possible solution in which split skin grafting might not be necessary.3 However, in studies discussing the effectiveness of ECMs (porcine-derived small intestine submucosa [SIS]; OASIS® Wound Matrix, Healthpoint Ltd, Fort Worth,Tex), a long list of exclusion criteria has been presented, such as 1) infection; 2) deep wounds exposing tendon, bone, or fascia; 3) uncontrolled diabetes; 4) chronic limb ischemia; 5) ABI < 0.80; 6) signs of cellulites and osteomyelitis; 7) undergoing hemodialysis, and more.4,5 Only 23% of the patients in this study could have been treated with the ECM according to these exclusion criteria.
The present study was designed to explore the contraindications of OASIS Wound Matrix. All patients in whom the wounds were fully debrided and granulated were treated with OASIS Wound Matrix. The exclusion criteria formulated in the reported literature were not followed in order to see if more patients could be successfully treated with OASIS Wound Matrix. The results, complications, and possible directives for further research are reported.
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