Use of synthetic electrospun fiber matrix in the sealing of tunneling, undermining, and cavity wounds.

Abstract

Background: Tunneling, undermining, and cavity wounds created by pressure, infection, or surgery present unique treatment challenges. These wound complications are prone to infection and may necessitate reconstructive flap procedures. Often patients are sarcopenic and malnourished, leading to complications or poor outcomes. The synthetic electrospun fiber matrix (SEFM) studied in this series is a fully synthetic, resorbable extracellular matrix that has shown promise in stimulating healing responses in challenging wound environments.

Objective: To evaluate whether the SEFM, in conjunction with proper wound care, supports rapid closure of wound tunneling or undermining, thus obviating the need for complex reconstruction.

Methods: A retrospective review of 9 patients with 11 multifactorial wounds treated with the SEFM was conducted. Patients who underwent a single application or serial applications of the SEFM to cavity, tunneling, or undermining wounds were included. All wounds underwent initial surgical sterilization with sharp excision prior to application. Healing progress, resolution of tunneling or undermining, and incidence of complications were assessed and documented at follow-up visits.

Results: These wound complications were successfully managed without extensive surgical reconstruction or amputation. Wounds ranged from acute to chronic (>2 years' duration) and were traumatic, iatrogenic, or secondary to pressure injuries or hidradenitis. Complete wound healing or granulation was achieved in all cases and, as possible to perform after healing, neither magnetic resonance imaging nor white blood cell sequestration showed further evidence of osteomyelitis. Durable results with no wound breakdown or signs of infection were noted at 6- to 18-month follow-up.

Conclusion: The SEFM successfully supported healing and collapse of wound tunneling and undermining in a complex patient population. The rapid resolution of these wound complications mitigated the need for large flap reconstructions and recommended amputations. More studies are needed to determine patient populations who would be best served by this technique.