Volumetric Tissue Infill of a Chronic Pressure Injury
Bariqa Salah M.D. and Heba Daradka
Jordan University Hospital
Pre-operative
Week 9
Results
- Myriad Matrix applied for volumetric fill, and Endoform applied in undermined area
- Significant size and depth reduction at 6 weeks
- STSG applied to expedite closure
- Small residual wound left at 9 weeks, and was closed with Endoform
Patient details
58-year-old female
Medical history
- > 6-month-old pressure injury
- Comorbidities: pre-diabetic, chronic kidney disease, paraplegic
Case details
- Wound size: ~40 cm x 20 cm
- Depth: 3-7 cm with undermining areas
- Failed free flap from prior surgery with exposed femur
Application photos
Pre-operative
Intra-operative - Myriad placement
- Mechanical debridement
- Placed Endoform Antimicrobial in the undermined peri-trochanteric area (not shown)
- Placed Myriad Matrix (5-Layer) 10 x 20 cm (2 devices)
- Secured via staples
- Non-absorbent contact layer
- NPWT, intermittent, 80 to 120 mmHg
- Secondary dressing change: once weekly
Day 10
- Significant volumetric fill of the defect
- Well vascularized granulation tissue
- Granulation tissue beginning to form over bony fragments of trochanter
- Placed a second Myriad Matrix graft (5-Layer) (10 x 20 cm)
Week 3
- Most of the granulation tissue has reached the wound edges
- Defect depth almost filled
- Placement of Endoform Natural (10 x 12.7 cm) under NPWT
Week 4
- Some residual Endoform present in the defect
- Further infill of the defect
- Further reduction of wound size and depth
- Full coverage of bony area
Week 5
- Some residual Endoform present in the defect
- Beefy granulation filling the entire defect
- Minimal exudation
- Further reduction of wound size and depth
Week 6
- Minimal exudation
- Wound size and depth slightly decreased
- Decision to place STSG was taken to expedite wound closure
Week 6.5
- 1 Week post placement of a STSG
- Majority of the STSG had taken and was well adhered to the bed, some blanching noted
- Endoform Natural placed on top of the STSG to protect and aid epithelialization
- Patient discharged from hospital
Week 9
- 2.5 weeks post placement of a STSG
- Small area left to re-epithelialize
- Close with Endoform Natural
For educational purposes only. Results may vary.