A Porcine Urinary Bladder Matrix for Neurosurgical Wounds

Abstract and Introduction

Abstract

Introduction: PUBM is a non-synthetic, completely resorbable xenograft product with a myriad of uses, including management of burns, acute and chronic wounds, soft tissue reinforcement, and hernia repair. The material is available in both powder and sheet forms which allows for excellent coverage of irregularly shaped wounds.

Case Report: The authors present 2 challenging neurosurgical wound cases. The first case is a large thoracolumbar wound secondary to a laminectomy complicated by a high output CSF fistula and dermal dehiscence. The second case is a deep postoperative surgical site infection in the setting of a large amount of surgical hardware. Both cases were successfully managed to complete wound healing with PUBM.

Conclusion: Neurosurgical wounds can be technically challenging and difficult to manage. CSF fistulas lack evidence for standard treatment strategy, making complications and chronic wounds more likely. The application of PUBM in the closure of neurosurgical wounds has not been thoroughly studied and may lead to improved wound closure.

Introduction

PUBM is a xenograft used for surgical reinforcement and management of soft tissue wounds and burns. It is composed of an ECM derived from the inner 2 layers of the porcine urinary bladder, specifically, the epithelial and lamina propria layers.^[1] This completely resorbable xenograft accelerates wound healing by facilitating constructive remodeling. The xenograft seems to have antimicrobial properties; however, studies have shown that the antibacterial activity is not due to the ECM itself but instead results from its degradation products.^[2] This includes activity against both gram-positive Staphylococcus aureus and gram-negative Escherichia coli.

Once the ECM is implanted, it initiates recruitment of white blood cells as well as fibroblasts into the scaffold to facilitate constructive remodeling. Fibroblasts deposit collagen to increase the strength and integrity of the tissue, and neovascularization occurs through endothelial growth factors including VEGF. Host tissue at the site of the reconstruction receives signals from the ECM to stimulate an adaptive response. The matrix is ultimately reabsorbed into the tissue, thus requiring no extraction or removal process after healing has been achieved. In this report, 2 cases of neurosurgical wounds successfully managed with PUBM are described.