Applications in Plastic Surgery

Acute Abdominal Wall Dehiscence With EPIFIX^®6

Challenge

62-year-old obese male, BMI of 29, type II diabetes, with a history of hypertension, myocardial infarction with stent placements, multiple abdominal surgeries, and over forty years of cigarette smoking, underwent large ventral hernia repair. At one week post op, the patient developed ischemia at the incision line, which led to an incisional dehiscence.

Studies have shown a direct correlation between the number of comorbidities and clinical outcomes. A significant rise in complications, length of stay, and mortality rates is associated with the rise in number of patient comorbidities.^7-9

Surgical Intervention

The patient was managed with serial debridement and wet-to-dry dressings for two months, then placed on negative pressure wound therapy (NPWT) for four weeks at home. After one month of NPWT, the wound had only decreased by 30%. NPWT was discontinued, and DHACM (Dehydrated Human Amnion/Chorion Membrane) was applied every other week, instead of weekly, due to the travel distance for the patient. The product provides a barrier that supports the healing cascade and protects the wound bed to aid in the development of granulation tissue in acute and chronic closures. The PURION process preserves ECM components.^2,3

Follow-Up

Upon examination at his two month follow-up visit, the wound was fully closed and re-epithelialized. The patient returned for a routine one-year visit and has remained fully closed and asymptomatic.

Following Debridement

Four weeks of NPWT, only 30% size reduction, first DHACM 4 cm x 4 cm applied

Week 2: Two 2 cm x 3 cm DHACM applied

Week 4: One 2cm x 3 cm DHACM applied

Week 8: Wound closed and stable

Clinical History

Patient presented with keloid scar after Caesarean section procedure.

Treatment

EPIFIX is a dehydrated human amnion/chorion membrane allograft. The product provides a protective barrier that supports the healing cascade and protects the wound bed to aid in the development of granulation tissue in acute and chronic closures. EPIFIX provides a biocompatible human ECM.1-3

Follow-Up

At year follow up, the one-third portion of the scar that was treated was greatly reduced in height and in color. Subsequent revision surgery managed the remaining two-thirds of the keloid scar with EPIFIX used to cover and protect the area.

KELOID Scar Revision with DHACM

Post-scar revision using DHACM on 1/3 portion of original scar

Scar one year post surgical treatment with DHACM overlay