title: Management of Open Distal Lower Extremity Wounds With Exposed Tendons Using Porcine Urinary Bladder Matrix.
abstract: Open wounds of the distal third of the leg and foot with an exposed tendon present a challenge in wound management and in attaining stable, durable coverage. The mobility of the tendon often leads to chronic inflammation that impedes wound closure, while the desiccation of the exposed tendon leads to progressive tendon necrosis. For the authors' cases, the ability of extracellular matrix (ECM) products to modulate wound bed inflammation and facilitate constructive remodeling of a wound seemed a reasonable approach in treating these wounds, especially in patients who are often poor surgical candidates for more advanced reconstructive procedures.
  
  
  METHODS
  The authors reviewed 13 patients who had open wounds of the distal third of the leg and/or foot that had associated tendon involvement in the wound (Achilles, 6; tibialis anterior, 6; and peroneal, 1). Patients' wounds were treated to total closure. The clinical course and patient management is reviewed herein.
  
  
  RESULTS
  The authors found newer ECM products can provide a more optimal method of management of patients with exposed tendons, as compared to prolonged negative pressure wound therapy.
  
  
  CONCLUSIONS
  Furthermore, the authors conclude the use of newer ECM products yields a more stable, less scarred, reconstructed wound that more closely resembles normal foot and ankle appearance compared to other more complex reconstructive operative procedures.
authors.affiliation: Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine.
authors.forename: Scott E
authors.initials: SE
authors.lastname: Geiger
authors.affiliation: Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine.
authors.forename: Olivier A
authors.initials: OA
authors.lastname: Deigni
authors.affiliation: Department of Orthopaedic Surgery, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: John Tracy
authors.initials: JT
authors.lastname: Watson
authors.affiliation: Division of Plastic and Reconstructive Surgery, Saint Louis University School of Medicine.
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Kraemer
mesh_terms: D000328:Adult; D000818:Animals; D005109:Extracellular Matrix / Q000378:metabolism* / Q000637:transplantation; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D054843:Negative-Pressure Wound Therapy; D019651:Plastic Surgery Procedures / Q000379:methods*; D044968:Regenerative Medicine; D012189:Retrospective Studies; D016038:Skin Transplantation / Q000379:methods*; D017695:Soft Tissue Injuries / Q000628:therapy*; D013524:Surgical Flaps / Q000098:blood supply; D013552:Swine; D013710:Tendons / Q000098:blood supply* / Q000473:pathology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000166:cytology / Q000637:transplantation*; D014945:Wound Healing