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Objective: Asymmetrical dimensions and nonlinear margins of a multilayered traumatic wound often preclude healing via primary intention. We present the case of an otherwise healthy 21-year-old male who sustained trauma following a boating accident. Method: The patient sustained three lacerations to the posterior thighs from the boat propeller. The most extensive wound measured 25×10×6cm of muscle extrusion with a divot fracture involving the posterior femur. Results: Primary closure and restoration of muscle biomechanics was achieved using a combination of a dynamic tissue system (DTS) and porcine urinary bladder matrix (PUBM) xenograft. After 24 days of treatment in hospital, the patient was discharged without the need for home health, outpatient wound care, or ongoing negative pressure wound therapy. The patient recovered full function of the legs and was cleared for participation in all activities. Conclusion: This complex traumatic boat propeller injury presented many challenges, including a transverse orientation on the extremity, degree of muscle injury/extrusion, and significant soft tissue loss. The combined application of a DTS with PUBM biological xenograft achieved a primary myocutaneous closure without the need for skin graft or flap reconstruction by plastic surgery. [ABSTRACT FROM AUTHOR]

Acute open abdomen with loss of domain is an extremely difficult surgical scenario, and secondary complications are common. This case describes a 33-year-old woman who initially underwent an elective, laparoscopic endometrioma resection during which a complete iatrogenic transection of the left ureter and part of the sigmoid mesentery occurred. After discharge 5 days later, she was immediately readmitted for worsening abdominal pain. During the emergency abdominal reexploration, an ischemic, perforated sigmoid colon was removed and large volume paracentesis was performed due to fecal contamination. Nine additional reexplorations over 2 months resulted in an extreme acute open abdomen with loss of domain. Viscera was protected with negative pressure wound therapy, but primary myofascial closure was not feasible. Through surgical collaboration between two institutions, an abdominal dynamic tissue system was installed, which achieved primary myofascial closure 31 days after installation. Nine days later, complete wound closure utilizing porcine urinary bladder matrix was accomplished. This case highlights the successful achievement of primary myofascial closure and complete wound healing without a surgical site infection or hernia development in this heavily contaminated abdomen using dynamic tissue system biomechanics with porcine urinary bladder matrix biologics., (Copyright © 2022 Baylor University Medical Center.)