title: The Use of Acellular Urinary Bladder Matrix as Coverage for Fasciocutaneous Free Flap Donor Sites: An Alternative to Traditional Grafting Procedures.
abstract: OBJECTIVE
  The purpose of this review is to 1) evaluate our early experience with urinary bladder matrix as a dressing for the management of complex wounds subsequent to fasciocutaneous or osteocutaneous vascularized tissue harvests, 2) assess coverage of exposed tendons and the duration of granulation and epithelial coverage, and 3) assess esthetic and functional outcomes compared with traditional means for the management of vascularized tissue harvest sites.
  
  
  METHODS
  This prospective study consisted of 8 consecutive patients in whom a substantial cutaneous component was harvested as part of a vascularized tissue reconstruction, which did not permit for primary closure (n = 7) or had skin graft failure (exposed tendon) that required additional treatment (n = 1).
  
  
  RESULTS
  Functional and esthetic outcomes were comparable to those of traditional methods of donor site closure as determined by clinical evaluation and subjective assessment by the patient. In all patients, no additional grafting was required to achieve full coverage. Irregularities of the wound achieved a level plane with granulation tissue an average of 3 to 4 weeks after surgery, followed by an additional 5 to 8 weeks for epithelialization. Wound care was minimal and included twice-daily wet-to-dry dressings. It was noted that complete wound healing was delayed in the urinary bladder matrix group, which required more attention during wound care when compared with published data. Advantages included facilitation of a robust granulation layer that leveled wound irregularities and avoidance of an additional skin graft site.
  
  
  CONCLUSIONS
  The use of urinary bladder matrix is a viable option for the rehabilitation of donor sites of vascularized tissue that include skin. Benefits include the avoidance of an additional skin graft donor site, facilitation of epithelialization over exposed tendons, leveling of the donor site texture, and an equivalent esthetic result compared with current practices for wound coverage. The success of this technique may be limited by the cost of materials and the protracted course for wound epithelialization.
authors.affiliation: Assistant Professor, Oral and Maxillofacial Surgery, Oral, Head & Neck Oncology and Microvascular Surgery, The University of Texas Health Science Center at Houston, Houston, TX. Electronic address: James.C.Melville@uth.tmc.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Melville
authors.affiliation: Chief Resident, Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Bennetts
authors.affiliation: Third-Year Dental Student, School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Lauro
authors.initials: L
authors.lastname: Tijerina
authors.affiliation: Assistant Professor, Oral and Maxillofacial Surgery, Oral, Head & Neck Oncology and Microvascular Surgery, The University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Shum
mesh_terms: D005205:Fascia / Q000637:transplantation; D005260:Female; D058752:Free Tissue Flaps; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016038:Skin Transplantation; D060053:Transplant Donor Site / Q000601:surgery*; D001743:Urinary Bladder / Q000637:transplantation*; D014945:Wound Healing