PMC7871006_01
Flap advancement and ECM stabilization of an abdominal dehiscence. Case 1:(A) Erosion of the abdominal tissues resulting from a gastric band and failed previous surgical reconstruction of the ~11-month-old defect. (B) Wide excision of the defect down to the underlying fascia and adipose tissue. (C) Placement of the ECM graft into the base of the defect prior to flap advancement and closure. (D) Seven days post-op. Remained healed at 6 months.
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F1
The defect was causing moderate pain, but was clean with no evidence of infection and hypertrophic granulation tissue was present (Figure 1A). Surgical incision was made at the defect margins, through subcutaneous adipose tissue and down to the fascia (Figure 1B). An ECM graft (Myriad , "Thick") was trimmed to fit the defect and placed onto the fascia (Figure 1C). After seven days, cutaneous tissues demonstrated good apposition and tissues exhibited no inflammation (Figure 1D), the NPWT and drain were removed and patient was discharged with instruction to wear abdominal binder and 6 weeks heavy lifting/strenuous activity restriction.
PMC7871006_02
Surgical reconstruction of recalcitrant sacral pressure injury. Case 2:(A) Eleven-month-old pressure injury that had previously failed a flap reconstruction 1 month prior; secondary procedure performed using ECM graft to stabilize the flap. (B) Excision of ulcer with partial ostectomy. (C) Placement of the ECM graft and (D) flap closure.
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F2
The flap had subsequently dehisced and while there were no signs of infection, the defect was chronically inflamed (Figure 2A). Defect was excised with side margins down to the coccyx, with a partial ostectomy (Figure 2B). An ECM graft (Myriad , "Thick") was trimmed to fit the defect and into the base of the defect and covering the bone protrusion of the coccyx (Figure 2C). The excision was closed via a flap advancement with suture used to the close the primary incision line (Figure 2D).
PMC7871006_03
Reconstruction of a non-healing lower extremity surgical defect. Case 3:(A) Thirteen-month-old non-healing defect following open reduction and internal fixation surgery of the left ankle. (B) Surgical excision of proximal chronic tissues and placement of the ECM graft into the defect. (C) Flap advancement and closure. (D) The defect exhibited signs of infection and secondary dehiscence 1-week post-surgery and was treated with a second ECM graft. (E) At 6 weeks, the defect demonstrated marked improvement with healthy granulation tissue development. (F) Successful closure of the defect by secondary intention was achieved 8-weeks after the initial flap reconstruction without additional surgical intervention.
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F3
Twenty-six-year-old female with a 13-month-old non-healing full thickness defect following open reduction and internal fixation surgery of the left ankle (Figure 3A). Surgical excision of proximal chronic tissues was carried out (Figure 3B). Trimmed ECM graft (Myriad  "Thin") was placed contacting the tissues of the defect bed and allowed to rehydrate in situ via absorption of blood components (Figure 3B). The defect was closed by flap advancement (Figure 3C) and underwent incisional NPWT for seven days. The defect exhibited signs of infection and secondary dehiscence 1-week post-surgery (Figure 3D). Additional ECM graft material was packed in the dehiscence cavity (Figure 3D) and covered with a gentian violet/methylene blue foam secondary dressing. Over the following weeks, the defect demonstrated marked improvement with healthy granulation tissue development (Figure 3E). Successful closure of the defect by secondary intention was achieved 8 weeks after the initial flap surgery (Figure 3F).