Background:Achieving a vascularized granulation bed is essential prior to split-thickness skin grafting (STSG) but is often protracted with existing dermal substitutes. Porcine-derived extracellular matrix (pECM) powder (XCelliStem Wound Powder; StemSys) supplies structural proteins and growth factors that may shorten this interval. Methods:Three adults with complex wounds-a traumatic dorsal-foot defect, a cervical burn contracture reconstructed with a latissimus flap, and a free omental flap to an upper-extremity degloving injury-received intraoperative application of hydrated pECM powder following meticulous debridement. Wounds were covered with Xeroform and either hypochlorous-soaked gauze or negative pressure wound therapy. Granulation, exudate, and infection were assessed daily; STSG was performed once a uniform, vascular bed formed. Patients were followed for ≥3months. Results:Complete, healthy granulation tissue developed on post-application days 9, 11, and 13, respectively, enabling timely STSG. All grafts achieved 100% take without necrosis, seroma, or infection. At 3 months, each site displayed durable coverage, preserved function, pliable scars with preserved elasticity, and high patient satisfaction. Conclusions:In this preliminary series, pECM powder accelerated wound bed readiness and supported reliable STSG within 2 weeks-substantially faster than the 3- to 7-week intervals reported for Integra Bilayer Matrix (Integra LifeSciences Corp) and NovoSorb Biodegradable Temporizing Matrix (PolyNovo Ltd). The pECM powder appears safe, easy to apply, and may reduce morbidity and resource use; controlled trials are warranted.
Background:Global abdominal wall distention (GAWD) is a phenomenon in which patients present with significant abdominal wall laxity and abdominal bulging unexplained by a rectus diastasis, large panniculus, or abdominal wall hernia. Traditional abdominoplasty techniques do not adequately address GAWD, and treatment of this condition requires modification of the abdominal fasciomuscular complex. This paper aims to describe a novel technique, known as wide-rectus abdominis fascia advancement (WRAFA), developed to address this vexing cosmetic issue. Methods:Over a 30-year period, patients with GAWD were identified in a single surgeon's practice, and, once deemed to be appropriate candidates, they underwent the WRAFA procedure. All patients underwent the procedure in an outpatient setting and were kept for no longer than 23 hours or transferred to a certified recovery setting with skilled nursing. Aesthetic outcomes and complications were tracked over time. Results:Six hundred eighty-five patients underwent abdominoplasty with the WRAFA technique. Two hundred eighty-four patients were available for follow-up for a minimum of 12 months. The average body mass index was 32. The median age was 38 years. Sex distribution was predominantly female (92.5% vs 7.75%). Aesthetic results were deemed to be good to excellent in 80% of patients, moderate in 15%, and minimal in 5%. None of the patients developed abdominal compartment syndrome. There were no fatalities or recurrences. One patient developed a unilateral lower quadrant hernia 15 years after the operation. Conclusions:The WRAFA technique helps redefine the patient's waistline while addressing functional muscular dystonia, ultimately providing excellent aesthetic and functional improvements.
