Bovine-derived collagen matrix as an adjunct in stage 3 pressure injuries: a case series of lower extremity wounds

Objective: Hard-to-heal (chronic) stage 3 pressure injuries (PIs) in medically complex patients are often refractory to standard treatments, and pose significant risks of infection, limb loss and diminished quality of life. Adjunctive use of advanced biologic materials, such as bovine-derived collagen matrices, may support more efficient wound resolution in these high-risk populations. Method: In this retrospective case series, patients with hard-to-heal stage 3 PIs of the lower extremity were treated with a single application of a bovine-derived collagen matrix as part of a multidisciplinary wound care protocol. All patients had significant comorbidities, including diabetes and dementia, as well as mobility impairments, such as peripheral neuropathy and multiple sclerosis with paraplegia. Interventions included debridement, a single application of a bovine-derived collagen matrix, appropriate wound dressings and pressure offloading. Results: All three patients (each with one PI) had failed to respond to prior standard wound care and their PIs had persisted from four weeks to approximately three years before treatment. Following a single application of the collagen matrix, complete wound closure was achieved within 27–52 days. Early wound responses were notable: one PI showed a 98% area reduction by day 14, another reduced by 76% by day 6, and in Case 2, closed by primary intention, stable closure was observed as early as day 3. No repeat applications of the bovine-derived collagen matrix were required, and no complications or recurrences were observed at follow-up. Conclusion: This case series highlights the potential of bovine-derived collagen matrix as an effective adjunct to comprehensive wound care in medically complex patients with stage 3 PIs that have persisted for several months to years, despite prior standard treatments. In all cases, complete wound closure was achieved following a single application of collagen matrix, highlighting its potential utility in the management of hard-to-heal PIs. Further prospective studies are warranted to validate these outcomes.