Authors (including presenting author) :
Pun MK (1), Chong HM (2)
Affiliation :
(1) Nursing Services Division, NTWC, (2) Department of Surgery, NTWC
Introduction :
The presence of bare-bone exposure in wounds poses significant reconstructive challenges, primarily due to inadequate vascularity. When flap procedures are not amenable, or the wound is not graftable, synthetic dermal substitutes emerge as a viable alternative. As clinical experience with synthetic dermal substitutes has expanded, these materials have effectively facilitated closure and staged reconstruction of complex wounds. However, in recent practice and manufacturer recommendations, such procedures often require surgical intervention and general anaesthesia.
Objectives :
This study focuses on the authors’ experiences using synthetic dermal substitutes as a bedside procedure in both ward and outpatient settings. The authors address challenging wounds with avascular structures, such as bare-bone exposure.
Methodology :
This retrospective case series examined patients treated with synthetic dermal substitutes at Tuen Mun Hospital in Hong Kong between January 2024 and December 2024. The authors meticulously documented patient demographics and outcome data, which encompassed wound etiology, the type and location of synthetic dermal substitute application, pain levels, wound progression through serial clinical photographs, and the time taken to achieve wound closure. Notably, all procedures were performed at the bedside without invasive techniques. In some instances, negative pressure wound therapy was employed to secure the synthetic dermal substitutes, enhancing cellular infiltration.
Result & Outcome :
The study involved five wounds across five patients (n=5). The wound etiologies included three cases of post-flap surgery for nasal squamous cell carcinoma with bone exposure, one case of a Stage 4 pressure injury with bone exposure, and one neuropathic ulcer with bone exposure. As of the latest follow-up, wound closure was achieved in four out of five cases (n=4), with closure times ranging from 10 to 14 weeks. Of the remaining wounds, unfortunately, that patient (n=1) passed away before closure could be attained.
Conclusion
Synthetic dermal substitutes have proven reliable coverage for avascular structures, such as bare-bone exposure. This case series highlights that synthetic dermal substitutes can expedite wound healing, reduce pain, and minimize scarring, resulting in favourable cosmetic outcomes. Furthermore, the non-surgical approach to applying these substitutes is new, safe, effective, and practical in managing difficult-to-heal wounds.
