Porcine-derived micromatrix: an alternative to immediate closure in the setting of acute ophthalmic trauma

Abstract

Introduction
Urinary bladder matrix is a skin substitute material from a porcine donor used extensively as a wound healing scaffold. Currently this product is used in the treatment of burns, post-surgical wounds, and reconstruction of skin defects. This form of xenograft provides a source of collagen, fibronectin, proteoglycan, and elastin to accelerate tissue granulation particularly in patients who are poor surgical candidates and lack tissue healing (eg, diabetes, radiation treatments and active chemotherapy). The graft acts as a biological dressing to prevent desiccation and facilitate early wound healing. We report the use of porcine bladder matrix in the setting of periocular trauma used for anterior lamellar reconstruction as an adjunct to immediate closure with flaps or grafts.
Report
All three cases involved young (29, 31, and 34 years of age) African American males who presented as level 2 traumas with complex facial lacerations secondary to motor vehicle accidents of similar magnitudes. To avoid a primary autologous skin graft, urinary bladder matrix was applied to the wound bed to allow accelerated healing by secondary intention. Following four treatment cycles, there was a significant degree of improvement in eyelid granulation and notable reduction in the size of eyelid defect. Despite complete granulation of the wound, significant retraction of the upper lid prompted further intervention and reconstruction.
Discussion
Cicatricial changes, especially secondary to traumatic injury, can result in substantial dystrophic wound healing and distortion of the eyelid structures. This can further lead to lagophthalmos, epiphora, and exposure keratopathy Standard surgical management options include scar tissue lysis, ectropion repair, and autologous skin grafting to lengthen the anterior lamella.Our case series describes an immediate solution by demonstrating the significance of porcine bladder matrix as an alternative to immediate closure in treatment of primary facial and periocular trauma with complex skin loss.