Extracellular Wound Matrix (OASIS®): Exploring the Contraindications. Results of Its Use in 32 Consecutive Outpatient Clinic
- 0 Comments
- 13640 reads
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.
1. Mauro T. Natural course of wound repair versus impaired healing in chronic skin ulcers. In: Shai A, Maibach HI, eds. Wound Healing and Ulcers of the Skin. Heidelberg, Germany: Springer; 2005:7–18.
2. Menke H, Klein A, John KD, Junginger T. Predictive value of ASA classification for the assessment of the perioperative risk. Int Surg. 1993;78(3):266–270.
3. Miner K. Porcine xenagraft as an alternative treatment to STSG for acute trauma wound. Presented at the Symposium on Advanced Wound Care, April 30–May 3, 2006, San Antonio,Tex.
4. Mostow EN, Haraway GD, Dalsing M, Hodde JP, King D; OASIS Venus Ulcer Study Group. Effectiveness of an extracellular matrix graft (OASIS Wound Matrix) in the treatment of chronic leg ulcers: a randomized clinical trial. J Vasc Surg. 2005;41(5):837–843.
5. Demling RH, Niezgoda JA, Haraway GD, Mostow EN. Small intestinal submucosa wound matrix and full-thickness venous ulcers: preliminary results. WOUNDS. 2004;16(1):18–22.
6. International Working Group on the Diabetic Foot. International Consensus on the Management and the Prevention of the Diabetic Foot: 2003. Brussels, Belgium: International Diabetes Federation; 2003.
7. Wollina U, Liebold K, Schmidt WD, Hartmann M, Fassler D. Biosurgery supports granulation and debridement in chronic wounds—clinical data and remittance spectroscopy measurement. Int J Dermatol. 2002;41(10):635–639.
8. Wolff H, Hansson C. Larval therapy—an effective method of ulcer debridement. Clin Exp Dermatol. 2003;28(2):134–137.
9. Courtenay M,Church JC,Ryan TJ. Larva therapy in wound management. J R Soc Med. 2000;93(2):72–74.
10. Church JC, Courtenay M. Maggot debridement therapy for chronic wounds. Int J Low Extrem Wounds. 2002;1(2):129–134.
11. Mumcuoglu KY, Ingber A, Gilead L, et al. Maggot therapy for the treatment of intractable wounds. Int J Dermatol. 1999;38(8):623–627.
12. Wilson JA, Clark JJ. Obesity: impediment to postsurgical wound healing. Adv Skin Wound Care. 2004;17(8):426- 435.
13. Second European Consensus Document on chronic critical leg ischemia. Circulation. 1991;84(4 Suppl):IV1–26.
14. Helton WS, Fisichella PM, Berger R, Horgan S, Espat NJ, Abcarian H. Short-term outcomes with small intestinal submucosa for ventral abdominal hernia. Arch Surg. 2005;140(6):549–562.
15. Franklin ME Jr., Gonzalez JJ Jr., Glass JL. Use of porcine small intestinal submucosa as a prosthetic device for laparoscopic repair of hernias in contaminated fields: 2- year follow-up. Hernia. 2004;8(3):186–189.
16. Gupta A, Zahriya K, Mullens PL, Salmassi S, Keshishian A. Ventral herniorrhaphy: experience with two different biosynthetic mesh materials, Surgisis and Alloderm. Hernia. 2006;10(5):419–425.
17. Niezgoda JA, Hermann K. Clinical experience with Oasis Wound Matrix for the treatment of venous and diabetic ulcers. Presented at the Symposium on Advanced Wound Care,April 30–May 3, 2006, San Antonio,Tex.