THE USE OF URINARY BLADDER

MATRIX (ACELL) IN THE TREATMENT OF

COMPLICATED OPEN WOUNDS

Alexis Lanteri Parcells, M.D Ian C. Hoppe, M.D. Brenon Abernathie, M.D. Ramazi O. Datiashvili, M.D. Ph.D

University of Medicine and Dentistry of New Jersey Division of Plastic Surgery Department of Surgery Newark, NJ USA

Background

• Annual wound care cost to the US healthcare system is

more than $20 billion

• Management of complicated open wounds is a challenge

when reconstructive options are not applicable

• Cellular and molecular research conducted by Badylak in

2002 demonstrated that scaffolds derived from urinary

bladder matrix provide a biocompatible material that

allows inductive tissue remodeling and wound closure

Urinary Bladder Matrix (UBM) •

•Core Structure: bimodal surface

• Epithelial basement membrane

• Lamina propria

• Growth factors

•Healing Response

• Autologous progenitor stem cells

• Chemotactic and mitogenic activity

• Antimicrobial activity

• Site-specific tissue remodeling

Material & Methods

• 5 Patients

• Weekly dressing changes

• Mean length of treatment: 20 weeks

• Result of treatment: 100% wound healing

Case Presentation

A 61-year-old woman sustained a severe crushing injury to her right knee.

At an outside institution, the wound was debrided and patella removed.

The patient developed a large open wound of the anterior knee with exposed knee joint.

A gastrocnemius muscle transfer and TRAM were attempted and both failed.

VAC therapy alone was attempted and was unsuccessful.

The patient developed occlusion of her SFA and acute DVT, which precluded further reconstruction.

The patient was told she may need an above-the-knee amputation.

After consultation and evaluation at UMDNJ University Hospital, we managed the wound by application of

Acell UBM in combination with VAC therapy at this initial stage

In 8 weeks

Case Presentation

In 16 weeks

VAC Therapy Discontinued

Case Presentation

In 24 weeks

The wound completely closed

Case Presentation

Conclusions

• Our experience shows urinary bladder matrix to be an

effective method in management of complicated open

wounds in selected cases

• Further studies need to be implemented to confer this

conclusion

References • Harding KG, Morris HL, Patel GK. Science, medicine and the future: healing chronic wounds. BMJ.

2002;324(7330):160–3

• Badylak SF. The extracellular matrix as a scaffold for tissue reconstruction. Semin Cell Dev Biol

2002; 13: 377-83

• Brown B, Lindberg K, Reing J, et al. The basement membrane component of biologic scaffolds

derived from extracellular matrix. Tissue Eng. 2006 Mar; 12(3):519-26.

• Hodde JP, Ernst DM, and Hiles MC. An investigation of the long-term bioactivity of endogenous

growth factor in OASIS wound matrix. J Wound Care 14(1), 23, 2005.

• Hodde J. Naturally occurring scaffolds for soft tissue repair and regeneration. Tissue Eng

2002;8:295-305.

• Beattie A, Gilbert TW, Guyot J, et al. Chemoattraction of progenitor cells by remodeling

extracellular matrix scaffolds. Tissue Eng. Part A. May 2009, 15(5): 1119-1125.

• Reing JE, Zhang L, Myers-Irvin J, et al. Degradation products of extracellular matrix affect cell

migration and proliferation. Tissue Eng Part A. 2009 Mar;15(3):605-14.

• Brennan EP, Reing J, Chew D, et al. Antibacterial activity within degradation products of biological

scaffolds composed of extracellular matrix. Tissue Eng. 2006 Oct; 12(10):2949-55.

• Gilbert TW, Nieponice A, Spievack AR, et al. Repair of the thoracic wall with an extracellular matrix

scaffold in a canine model. J Surg Res. 2007 Oct 18.