The Use of Extracellular Matrix in the Complex Reconstruction of the Lower Leg After Massive Avulsion

Summary: We present here the case of a 30-year-old patient with severe avulsion injuries who had a successful reconstruction with extracellular matrix (ECM), split-thickness skin graft (STSG), and vacuum-assisted closure therapy, highlighting the benefits of these innovative treatments in complex trauma care. Avulsion injuries caused by trauma result in the tearing of soft tissues (skin and subcutaneous tissue) with exposed neurovascular structures, tendons, muscles, and bone, and pose a major challenge for surgical treatment. Conventional methods often include necrectomy and primary closure, STSG, and local or distant (free) flaps. The new approaches we propose include the use of ECM with STSG and vacuum-assisted closure therapy, which offered promising results: shorter surgical time, faster recovery and healing, equal or better aesthetic and functional outcome, and no loss of function in the donor area. The ECM acts as a biocompatible scaffold that promotes cell migration and tissue regeneration, which is crucial for wound healing.