Juliane Y Cruz, MD1, Elyse Leevan, MD1, Kristine Verdell, RN2, Gabriel Akopian, MD, MBA2, Howard S Kaufman, MD, MBA1. 1Huntington Hospital, 2Huntington Medical Research Institutes
Objective of Technology: Perianal disease occurs in up to 24% of patients with Crohn's disease (CD) and can manifest as deep fissures/ulcers, abscesses, fistulae, non-healing wounds, and large hypertrophic skin tags. Persistent severe perianal fistulizing disease requires appropriate surgical drainage including catheters and Setons followed by medical therapy with biologics, and in some cases, fecal diversion. Patients often suffer from non-healing wounds that weep fluid, and additional anorectal surgery can be associated with disease and progression. Recent advances in non-CD (traumatic, diabetic, and orthopedic) wound care have included debridement and xenografting with porcine urinary bladder matrix (UBM) products. These techniques have been associated with improvements in chronic wounds healing including complete wound closure. Given the chronicity of perianal CD, UBM may be useful as an adjunct to incision and debridement in promoting wound healing.
Description of Technology: Matristem UBMTM (ACell, Coumbia, MD) is an extracellular matrix derived from porcine urinary bladder which is intended for use in chronic wounds, including draining wounds. UBM is available in both a powder (Micromatrix) and sheet form (Matristem). The products include both an intact epithelial basement membrane on one surface and a lamina propria on the opposite surface as well as carbohydrates, collagens, and proteins. UBM facilitates a remodeling process during wound healing. Over time these components are resorbed and have been found to promote healing and reduce infection.
Preliminary Results: Our patient is a 56 year old male with an 8 year history of CD that included primarily perianal disease with abscesses, fistulae, off-midline fissures, and symptomatic large anal tags. He had minimal small and large intestinal CD. Medical therapy included intermittent antibiotics and 6-mercaptopurine. His surgical history included several incision and drainages, debridements, and Seton placements, all performed in the absence of active rectal CD. Despite eventual resolution of abscesses and fistulae, the patient developed chronic fissures and ulcers of the perianal region. He was offered treatment with biologics, but ultimately chose to undergo serial debridements and xenografting with UBM over approximately 1 year. At 5 months from the final procedure, all of the wounds remain completely healed, and he has no perianal symptoms.
Conclusions/Future: Xenografting with porcine UBM was associated with complete healing of deep fissuring and fistulizing perianal CD in this patient. Wound closure occurred in a contaminated field without the need for escalation of medical therapy or fecal diversion. Additional studies are needed to validate the effectiveness of porcine UBM in promoting resolution of nonhealing perianal disease.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91152
Program Number: ETP837
Presentation Session: Emerging Technology iPoster Session (Non CME)
Presentation Type: Poster