Surgical management of stage 3 and 4 pressure injuries in trauma patients using ovine forestomach matrix grafts: a prospective case series

Introduction: Stage 3 and 4 pressure injuries (PIs) pose significant challenges in trauma patients. Surgical management aims to support improvements in tissue vitality and often relies on debridement and negative pressure wound therapy. The use of ovine forestomach matrix (OFM)-based grafts to augment existing surgical approaches may improve tissue quality prior to reconstruction or closure by secondary intention. Methods: This prospective observational study is part of a larger Institutional Review Board-approved study (Registry: ClinicalTrials.gov. Clinical trial number: NCT05243966). The study enrolled patients with Stage 3 and 4 PIs between July 2022 and July 2024 at a single level 1 trauma center. The study's primary endpoint was the incidence of postoperative complications and secondary endpoints included time to granulation tissue coverage and/or fill, percent area reduction, and number of OFM applications. Results: , and 10 of the 12 enrolled PIs included areas of tunneling and/or undermining. The median time to 50% granulation tissue was 2.0 (IQR: 1.5, 8.5) weeks and the median time to complete granulation tissue coverage was 6.5 (IQR: 2.0, 15.0) weeks. Tunneling or undermining was eradicated in 50% of PIs. The mean percent area reduction at the last recorded visit was 61% ± 30%. There were no postoperative complications. Conclusion: These results suggest that OFM-based grafts may serve as a valuable adjunct for the surgical management of late-stage PIs that are clinically challenging to heal.