(CS-056) Pyoderma Gangrenosum Wounds Treated with a Synthetic Hybrid-Scale Fiber Matrix*

Pyoderma gangrenosum (PG) is a rare inflammatory skin disease which presents with painful skin ulcers.¹ These ulcers often occur on the lower extremity, and present with peripheral erythema and undermined borders.¹ Systemic treatment with immunosuppressant medication is the typical first line treatment, however there is currently no gold standard in wound management.¹ A synthetic hybrid-scale fiber matrix, with a size and structure similar to human extracellular matrix, has shown promise in healing difficult PG wounds in prior case studies.^2-3 By encouraging cellular infiltration and neovascularization through its engineered design, as well as minimizing inflammatory response, the synthetic matrix could offer a novel approach in PG wound treatment.^2-4

Methods:

A retrospective review of 2 patients treated with the synthetic hybrid-scale fiber matrix for pathologically confirmed PG wounds was conducted at a single site. Both patients had previously failed aggressive wound care treatment. Each patient received one application of the synthetic hybrid-scale fiber matrix to their PG wounds in conjunction with antimicrobial wound gel. Patients were followed clinically for wound healing progress and dressing changes.

Results:

The patient ages at the start of treatment were 60 and 64 years old. Both patients had a history of prior difficult to heal PG wounds. Co morbidities included venous insufficiency, hypertension, prior renal transplant, hyperparathyroidism, and rheumatoid arthritis. The starting wound sizes were 5.9 cm x 6 cm and 11.5 cm x 11 cm, and patients continue to undergo treatment with the synthetic hybrid-scale fiber matrix.

Discussion:

PG wounds can be difficult to manage given that standard treatment with repeat debridement and wound dressings can worsen the inflammatory response associated with these wounds.² A synthetic hybrid-scale fiber matrix may encourage wound healing in these patients by proving a synthetic scaffold to support cellular infiltration and differentiation within the wound bed.⁴ The synthetic nature also minimizes inflammatory response, which is vital to healing these often chronically inflamed wounds.^2,4

Trademarked Items: *Restrata® Acera Surgical, Inc., St. Louis, Missouri

References:

References:
1. Maverakis E, Marzano AV, Le ST, et al. Pyoderma gangrenosum. Nat Rev Dis Primers. 2020;6(1):81
2. Schultz A, Pynter T, Wireman G, et al. Utility of a synthetic hybrid-scale fiber matrix in the treatment of pyoderma gangrenosum: A case report. Proceedings of American College of Foot and Ankle Surgeons. Los Angeles, CA. February 9 – 12, 2023.
3. Figueroa S. Treatment of pyoderma gangrenosum with a synthetic hybrid-scale fiber matrix. Proceedings of Symposium on Advanced Wound Care. Las Vegas, NV. October 14-16, 2022.
4. MacEwan MR, Jeng L, Kovacs T, et al. Clinical application of bioresorbable, synthetic electrospun matrix in wound healing. Bioengineering. 2023;10(9):9.