(CS-040) Comparative Effectiveness of Ovine Forestomach Matrix and Fish Skin in the Surgical Management of Bilateral Hidradenitis Suppurativa

Introduction: Surgical management of Hurley stage III hidradenitis suppurativa (HS) typically involves the excision of diseased tissue and subsequent reconstruction, potentially leading to complications or recurrence of the disease (Seyed Jafari, Hunger, and Schlapbach 2020). Ovine forestomach matrix* (OFM) and fish skin graft^ (FSG) have been shown to be effective in wound healing and surgical reconstruction (Bosque et al. 2021; Chaffin et al. 2021; Bohn and Chaffin 2020; Esmaeili et al. 2023). The purpose of this case report was to evaluate the healing outcomes and handling properties of two commercially available xenografts in two similar lesions of the same patient.

Methods:

Patient was a 48-year-old male 1 pack/day smoker using IV biologic and long-term corticosteroids for severe psoriasis. The patient had a 10-15 year history of multiple severe Hurley stage III HS lesions. After excision of the defects, bilateral scrotal advancement flaps were performed. Due to patient co-morbidities and thin body habitus, the patient had minimal soft tissue laxity and was therefore deemed unsuitable for coverage of the entire defect with advancement flaps.

For the remaining open areas at the left groin and thigh and right groin and thigh (both defects measured ~15x5cm in comparable anatomic areas), a head-to-head comparison was made. OFM 3-layer graft was applied to the right defect and FSG on the left. Both grafts were bolstered identically to the defects with synthetic absorbable sutures, each dressed with the same contact layer, gauze, ABD, tape, and mesh underwear. The patient was followed outpatient with a plan for healing by secondary intention due to his smoking history.

Results: At day 20, the defect treated with OFM graft measured 15x3x0.4cm, while the matched defect treated with FSG measures 15x3.5x0.5cm. The OFM-treated defect had more robust neodermis formation with neo-epithelialization along the periphery. At the same timepoint, the FSG-treated defect had residual FSG graft present. There was no significant difference in drainage or pain on either side. No complications noted.

Discussion:

The preliminary findings of this single case demonstrate promising healing outcomes of both grafts with OFM-treated lesion showing faster formation of vascularized neodermal tissue.

Trademarked Items: *Ovine Forestomach Matrix: Myriad Matrix (Aroa Biosurgery, LTD, Auckland, NZ)
^Fish Skin Graft: SurgiClose (Kerecis, Isafjordur, Iceland)

References: Bohn, G. A., and A. E. Chaffin. 2020. 'Extracellular matrix graft for reconstruction over exposed structures: a pilot case series', J Wound Care, 29: 742-49.

Bosque, B. A., C. Frampton, A. E. Chaffin, G. A. Bohn, K. Woo, C. DeLeonardis, B. D. Lepow, M. M. Melin, T. Madu, S. G. Dowling, and B. C. H. May. 2021. 'Retrospective real-world comparative effectiveness of ovine forestomach matrix and collagen/ORC in the treatment of diabetic foot ulcers', Int Wound J, 2021 Aug 6: 741-53.

Chaffin, A. E., S. G. Dowling, M. S. Kosyk, and B. A. Bosque. 2021. 'Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series', J Wound Care, 30: S28-S34.

Esmaeili, A., E. Biazar, M. Ebrahimi, S. Heidari Keshel, B. Kheilnezhad, and F. Saeedi Landi. 2023. 'Acellular fish skin for wound healing', Int Wound J.

Seyed Jafari, S. M., R. E. Hunger, and C. Schlapbach. 2020. 'Hidradenitis Suppurativa: Current Understanding of Pathogenic Mechanisms and Suggestion for Treatment Algorithm', Front Med (Lausanne), 7: 68.