Patient PresentationAn 83 year old woman presented to the wound center with a stage IV pressure ulcer on the left posterior ankle measuring 11.2 x 6.0 x 0.2 cm with exposure of the Achilles tendon (Fig 1). The ulcer had developed while in a rehab facility, after experiencing an episode of deep vein thrombosis (DVT). Upon admission, Interventional radiology performed a recanalization and angioplasty of the posterior tibial artery (Fig 2a & 2b). Due to poor healing potential and severe peripheral artery disease, the leg was at high risk for amputation.

The ulcer was surgically debrided and Integra® Bilayer Wound Matrix (BWM) was applied to the clean wound, directly over the exposed tendon (Fig 3). Intra-operative cultures revealed heavy growth of oxacillin sensitive Staphylococcus aureus (OSSA) and pre-operative cefazolin was replaced by dicloxacillin. By POD 29, the BWM had granulated in well (Fig 4) and the silicone was removed. Unfortunately, there remained a small area of exposed tendon, so it was decided to apply PriMatrix® Dermal Repair Scaffold to the entire area to fully cover the tendon (Fig 5).

PriMatrix was completely adherent one week after application and completely covered the tendon and a collagen/ORC dressing was applied to prepare the wound for re-epithelialization. At 10 weeks post BWM application and 41 days after PriMatrix application, a beefy red granulation bed was apparent and AmnioExcel® Amniotic Allograft Membrane was applied to the wound (Fig 6) and reapplied weekly for 6 weeks.

By 16 weeks after BWM application, the open wound was reduced by more than 50% in area (Fig 7) and AmnioExcel continued to be applied every other week until complete re-epithelialization was achieved (Fig 8).

ConclusionOver the course of 30 weeks, sequential application of Integra Bilayer Wound Matrix, PriMatrix and AmnioExcel, this Stage IV pressure ulcer was closed, protecting the underlying Achilles tendon and salvaging this at-risk limb.

1

Generating Vascularized Tissue Over Exposed TendonAllen S. Sater, DPM Ankle & Foot Care Center, Jupiter FL

E X P O S E D T E N D O N

2A - Pre 2B - Post 3 4

5 6 7 8

Generating Vascularized Tissue Over Exposed Tendon

PriMatrix Dermal Repair Scaffold is a unique scaffold for the management of the most challenging wounds in the outpatient setting.

For more information or to place an order, please contact: United States, Canada, Asia, Pacific, Latin AmericaUSA 800-654-2873 888-980-7742 fax International +1 609-936-5400 +1 609-750-4259 fax integralife.com

Ordering Information

Reference Description Configuration

607-001-009 0.2 cm x 26.5 cm 3 units/box

607-005-014 14 mm Disc Meshed

607-005-018 18 mm Disc Meshed

607-005-220 2 cm x 2 cm Meshed

607-005-330 3 cm x 3 cm Meshed

607-001-440 4 cm x 4 cm Solid

607-004-440 4 cm x 4 cm Fenestrated

607-005-440 4 cm x 4 cm Meshed

607-005-550 5 cm x 5 cm Meshed

607-001-660 6 cm x 6 cm Solid

607-004-660 6 cm x 6 cm Fenestrated

607-005-660 6 cm x 6 cm Meshed

607-001-880 8 cm x 8 cm Solid

607-004-880 8 cm x 8 cm Fenestrated

607-005-880 8 cm x 8 cm Meshed

607-101-440 4 cm x 4 cm Solid Ag

607-104-440 4 cm x 4 cm Fenestrated Ag

607-105-440 4 cm x 4 cm Meshed Ag

607-101-660 6 cm x 6 cm Solid Ag

607-104-660 6 cm x 6 cm Fenestrated Ag

607-105-660 6 cm x 6 cm Meshed Ag

8 cm x 8 cm

Actual sizes shown

6 cm x 6 cm

4 cm x 4 cm

3 cm x 3 cm

2 cm x 2 cm

18 mm14 mm

5 cm x 5 cm

Availability of these products might vary from a given country or region to another, as a result of specific local regulatory approval or clearance requirements for sale in such country or region. n Non contractual document. The manufacturer reserves the right, without prior notice, to modify the products in order to improve their quality.n Warning: Applicable laws restrict these products to sale by or on the order of a physician.n Consult product labels and inserts for all indications, contraindications, warnings, precautions, and instructions for use.

PriMatrix, AmnioExcel, Integra, and the Integra logo are registered trademarks of Integra Lifesciences Corporation or its subsidiaries in the United States and/or other countries. ©2018 Integra LifeSciences Corporation. All rights reserved. Printed in USA. 1031239-1-EN

PriMatrix is intended for the management of wounds that include:• Partial and full thickness wounds• Pressure, diabetic, and venous ulcers• Second-degree burns• Surgical wounds-donor sites/grafts, post-Moh’s surgery, post-laser surgery, podiatric, wound dehiscence• Trauma wounds- abrasions, lacerations and skin tears• Tunneled/undermined wounds • Draining wounds

Contraindications

• PriMatrix should not be used for patients with a known history of hypersensitivity to collagen or bovine products.• PriMatrix is not indicated for third-degree burns.

Warnings and Precautions

• PriMatrix should be used with caution in regions where an infection exists or is suspected. Treat any existing infection appropriately. Potential Complications

The following complications are possible. If any of these conditions occur, the device should be removed: infection; chronic inflammation; allergic reaction; excessive redness, pain, swelling, or blistering.