Use of a dynamic tissue system and biological xenograft in complex traumatic wound closure.

OBJECTIVE: Asymmetrical dimensions and nonlinear margins of a multilayered traumatic wound often preclude healing via primary intention. We present the case of an otherwise healthy 21-year-old male who sustained trauma following a boating accident.

METHOD: The patient sustained three lacerations to the posterior thighs from the boat propeller. The most extensive wound measured 25×10×6cm of muscle extrusion with a divot fracture involving the posterior femur.

RESULTS: Primary closure and restoration of muscle biomechanics was achieved using a combination of a dynamic tissue system (DTS) and porcine urinary bladder matrix (PUBM) xenograft. After 24 days of treatment in hospital, the patient was discharged without the need for home health, outpatient wound care, or ongoing negative pressure wound therapy. The patient recovered full function of the legs and was cleared for participation in all activities.

CONCLUSION: This complex traumatic boat propeller injury presented many challenges, including a transverse orientation on the extremity, degree of muscle injury/extrusion, and significant soft tissue loss. The combined application of a DTS with PUBM biological xenograft achieved a primary myocutaneous closure without the need for skin graft or flap reconstruction by plastic surgery.