Porcine Urinary Bladder Extracellular Matrix for Treatment of Periocular Skin Defects

A case of necrotizing fasciitis of the orbit secondary to Aspergillus fumigatus and mixed flora

A 79-year-old female presented to the emergency department for sudden-onset ocular pain, edema, and erythema around her left eye. She also had a left-sided migraine and frontal fullness for 2 weeks. She had attentive care for the diagnosis of orbital cellulitis and prompt recognition of necrotizing fasciitis. Wound cultures were positive for over 5 strains of bacteria in addition to Aspergillus. In a combined effort by our institution's Ophthalmology and Otolaryngology departments, the patient was successfully treated with debridement, porcine bladder matrix, antibiotics, and antifungals. The authors describe the first reported case of eyelid and periorbital necrotizing fasciitis, caused by mixed flora and Aspergillus fumigatus, that showed promising wound healing with the outlined treatment paradigm.

Umbilical Cord Amniotic Membrane Graft as a Skin Substitute in Periocular Reconstruction: A Case Series

Loss of periocular skin due to cancer, trauma, or surgery is a major reconstructive challenge; resultant tissue contracture can cause eyelid malposition with poor functional and aesthetic outcomes. We describe the successful use of cryopreserved umbilical cord amniotic membrane as a wound covering and scaffold for periorbital anterior lamellar defects. This is a retrospective case series of 4 patients (mean 21 years, range 9-30 years, 3 male) who underwent periocular reconstruction with umbilical cord amniotic membrane of 9 different sites. Follow-up time ranged from 10 to 22 months. All wounds healed successfully with a good functional eyelid position. Umbilical cord amniotic membrane is readily available, has antibacterial and anti-inflammatory properties, provides a structural scaffold for cell adhesion and growth, and contains biological factors that promote cell proliferation/remodeling. We demonstrate that the umbilical cord amniotic membrane is an effective substitute for full-thickness skin grafting in the periocular area, particularly with skin loss secondary to burns and/or trauma.

Urinary bladder matrix for lower extremity split-thickness skin graft donor site

Split-thickness skin grafts (STSG) are commonly used to treat soft-tissue defects. Harvesting a STSG creates an additional partial thickness wound at the donor site which must be managed. Many dressings are commercially available for the management of STSG donor sites; however, there is no evidence-based consensus on optimal dressing for site management. Urinary bladder matrix (UBM) is an extracellular matrix that acts as a structural support for tissue remodeling and provides molecular components for repair. Common clinical applications of UBM include coverage of deep wounds, burns, and irradiated skin. Skin grafting from the lower extremities poses a challenge due to the increased dermal tension. UBM-based reconstruction is an alternative method of managing lower extremity skin graft donor sites. This case study demonstrates the use of UBM in the reconstruction of a STSG donor site of the anterolateral thigh, which resulted in satisfactory healing, no pain, and excellent cosmetic and functional outcomes.

Use of Porcine Urinary Bladder Matrix in Socket Reconstruction After Pediatric Orbital Exenteration

Reconstruction options after orbital exenteration can be challenging, time-consuming, and require intensive postoperative care. Engineered dermal acellular matrices offer a quick and easy option for wound healing that has proven to be successful in various settings. Specifically, the porcine urinary bladder matrix has demonstrated success in periocular and orbital wound healing. This report describes a pediatric patient who underwent repair with porcine urinary bladder matrix after orbital exenteration for recurrent alveolar rhabdomyosarcoma. The patient did not require any additional reconstructive procedures. To our knowledge, this is the youngest patient to receive a porcine urinary bladder matrix after exenteration.

The Three-Dimensional Structure of Porcine Bladder Scaffolds Alters the Biology of Murine Diabetic Wound Healing

OBJECTIVE

To determine if the various three-dimensional structures of bioscaffolds affect wound healing by investigating the efficacy of different porcine-derived urinary bladder matrix (UBM) structures in treating murine diabetic wound healing.

METHODS

The authors studied three different UBM structures: particulate (pUBM), one-layer freeze-dried sheet (fdUBM), and three-layer laminated sheet (lmUBM). Scanning electron microscopy images of the structures were used to calculate a wound-exposed surface-area-to-volume ratio. A 1.0 × 1.0-cm full-thickness dorsal wound was excised on 90 db/db mice. Mice were either untreated (blank, n = 15), treated with one UBM structure (pUBM, n = 15; fdUBM, n = 15; lmUBM, n = 15), or treated with a combination of either the one- or three-layer sheet over the particulate matrix (fdUBM + pUBM, n = 15; lmUBM + pUBM, n = 15). The authors obtained macroscopic images of the wounds and harvested tissues for analyses at multiple time points.

RESULTS

The surface area available to interact with the wound was highest in the pUBM group and lowest in the lmUBM group. Greater wound bed thickness was noted in the fdUBM, fdUBM + pUBM, and lmUBM groups compared with the blank group. Cellular proliferation was significantly higher in the fdUBM and fdUBM + pUBM groups than in the blank group. The lmUBM + pUBM group had the highest collagen deposition. The pUBM group induced significantly higher leukocyte infiltration compared with the lmUBM, lmUBM + pUBM, and blank groups. Microvessel density was highest in the fdUBM + pUBM group. Significant differences in the wound closure rate were noted between the blank group and the fdUBM and fdUBM + pUBM groups.

CONCLUSIONS

Assessment of the three UBM bioscaffold structures highlighted differences in the wound-exposed surface area. Variations in wound healing effects, including collagen deposition, cellular proliferation, and angiogenesis, were identified, with combinations of the structures displaying synergistic effects. This study serves as a platform for future scaffold design and offers promising evidence of the benefits of combining various structures of scaffolds.