Urinary Bladder Matrix Grafting Versus Flap Coverage for Acute or Infected Wound Defects in Patients With Orthopaedic Trauma

Objectives: Urinary bladder matrix (UBM) grafting of acute or infected wound defects has been reported to be successful in small case series. The purpose of this study was to compare the outcomes of UBM grafting with flap coverage. Design: This is a retrospective comparative study. Setting: Level-1 trauma center. Patients: Orthopaedic trauma patients with wound defects not amenable to primary closure or skin grafting. Intervention: Wound coverage with UBM grafting (n = 26) by orthopaedic trauma surgeons versus flap coverage (n = 26) by microvascular-trained plastic surgeons. Main Outcome Measurements: Primary wound coverage success, complications, returns to the operating room, hospital length of stay, and time to wound healing. Results: The UBM group was more likely to have an American Society of Anesthesiologist class >= 3 (58% vs. 23%, P = 0.02), a foot/ankle wound (77% vs. 12%, P < 0.001), an infected wound defect (81% vs. 50%, P = 0.03), and smaller defects (21 vs. 100 cm(2), P = 0.02). UBM grafting resulted in a longer time to wound healing (6 vs. 2 months, P = 0.002) and a shorter hospital length of stay (2 vs. 14 days, P < 0.0001). UBM and flap groups had similarly high rates of failure of primary wound coverage (31% vs. 31%; P = 1.0), complications (46% vs. 62%, P = 0.4), and returns to the operating room (46% vs. 65%; P = 0.2). All 3 acute traumatic wounds undergoing UBM grafting concurrently with fracture fixation experienced graft failure and osteomyelitis. Conclusion: UBM grafting is an effective alternative to flap coverage for small traumatic or infected wounds but should be avoided in acute traumatic wounds undergoing fracture fixation.