Use of Oasis Wound Matrix For Split-thickness Skin Graft Donor Sites
James C. Yuen, MD and Julio Hochberg, MD.
INTRODUCTON:Oasis(COOK Biotech, West Lafayette, IN)is a naturally derived biomaterial obtained from porcine intestinal submucosa, which acts as an extracellular matrix. This wound matrix functions as a scaffolding to support cell adherence and promotes rapid cellular proliferation and capillary ingrowth. This biomaterial contains key components of the dermal extracellular matrix such as collagen, elastin, glycosaminoglycans, glycoproteins, and proteoglycans, and growth hormones. Since its approval by the FDA in 2000, relatively few papers have been published (1-4). No articles have been reported describing the use of Oasis for dressing over split-thickness skin graft donor sites.
METHOD: From November 2003 to December 20006, we have utilized this wound matrix as a dressing over split-thickness donor sites in 131 patients. Our technique entails application of Oasis directly over the donor site. This is then covered with Xeroform (Kendall Inc., Mansfield, Mass.),Telfa (Kendall Inc., Mansfield, Mass.), and then 4 x 4 gauzes. To secure the dressing, we use Tagaderm (3M Health Care, St Paul, MN) tape for the smaller donor sites and a circumferential wrap with Kerlex for the larger thigh donor sites. We routinely change the first dressing at postoperative day 4 to 6. The first dressing is performed earlier if there is excessive drainage soaking through the dressing. The Oasis and Xeroform is left on. After the first dressing change, subsequent outer layers of Telfa (Kendall Inc., Mansfield, Mass.)and 4 X 4's are changed every two to three days until epithelialization is complete, at which point the Oasis and Xeroform spontaneously come off.
RESULTS: Epithelialization was complete in 1-3 weeks with an average of 2 weeks. Only two cases were there delayed healing beyond one month. Most remarkably, very few patients complain of significant pain at the skin graft donor site, since the Oasis wound matrix acted as a biological dressing protecting the nerve endings. The wound matrix forms a scab-like sealant which readily peels off when epithelialization is complete.
CONCLUSION: This wound matrix derived from porcine intestinal submucosa, with overlying Xeroform, provides for a low-maintenance dressing with good pain control.
REFERENCES
1. Hodde JP, Ernst DM, Hiles MC. An investigation of the long-term bioactivity of endogenous growth factor in Oasis Wound Matrix. J Wound Care 14:23-25, 2005.
2. Transforming growth factor-beta1 in a sterilized tissue derived from the big small intestine submucosa. J Biomed Mater Res 67: 637-640, 2003.
3. Niegoda JA, Van Gils CC, Frykberg RG, Hodde JP. Randomized clinical trial comparing Oasis Wound matrix to Regranex gel for diabetic ulcers. Adv Skin Wound Care 18:258-266, 2005.
4. Benbow M. Oasis: an innovative alternative dressing for chronic wounds. Brit. J Nursing. Br J Nursing 10:1489-1492, 2001.