Introduction
Pressure ulcers (PUs) affect 2.5 million people annually in the US, costing >$26.8 billion USD.1 Complications, such as significant tunnelling or undermining, can lead to delayed healing, prolonged hospital stays and increased costs. Collagen, a longstanding wound treatment, faces challenges, such as poor conformability to the wound bed, difficulty integrating with the body's tissue, and inconsistent promotion of wound healing in complex cases.2 An innovative three-dimensional (3D) porcine liver-derived collagen scaffold aims to treat deep and challenging wounds. Here, we present a case of a Stage 4 sacral PU treated with Miro3D wound matrix (Reprise Biomedical, Inc., US).3,4
Method
This case highlights a three-year Stage 4 sacral PU in an 82-year-old female patient with type 2 diabetes, hypertension and paraplegia, following a complicated fall injury and prolonged hospital stay. Healing was complicated by frequent hospitalisations and osteomyelitis, leading to her transfer to our facility. Upon initial evaluation, the wound measured 4.3×3.5×0.5cm, with a tunnelling tract 1.5 cm long at the one o’clock position, and an undermining rim 1.3 cm deep from the 10 o’clock to 4 o’clock positions. A revised treatment plan resolved the tunnelling tract, reducing the overall wound size. However, the undermining rim persisted. At one year later, the sacral PU had reduced to 2.4×1.7×0.5 cm, with a 0.75 cm undermining rim from 12 o’clock to 3 o’clock. Miro3D applications were initiated once weekly.3
Results
With weekly follow-up, the sacral wound decreased in size, with the undermining rim resolving in four weeks. After four Miro3D applications, the wound closed. The 3D wound matrix resolved PU of three years’ duration in just six weeks, and the site remains closed at the time of writing.
Conclusion
The 3D wound matrix is 2cm thick and designed to cover deep, tunnelling and irregular wounds.3 This conformable cubical matrix is effective in resolving challenging wounds with decreased healing time when used in complicated cases. Studies support the effectiveness of cellular, acellular and matrix-like products in wound repair and regeneration.5