Journal of Surgical Case Reports, 2023, 9, 1–3

https://doi.org/10.1093/jscr/rjad529
Case Report

Case Report
Urinary bladder matrix for lower extremity
split-thickness skin graft donor site
1,
Sydney Bormann *, Zachary Lawrence2 , Heather Karu3

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1 University
of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD 57105, United States
2 Department of Surgery, University of South Dakota Sanford School of Medicine, 1400 W 22nd St, Sioux Falls, SD 57105, United States
3 Department of Plastic and Reconstructive Surgery, Sanford Health, 1500 W 22nd St, Sioux Falls, SD 57105, United States

*Corresponding author. Sanford School of Medicine, University of South Dakota, 1400 W 22nd St, Sioux Falls, SD 57105, United States.
E-mail: sydneylbormann@gmail.com

Abstract
Split-thickness skin grafts (STSG) are commonly used to treat soft-tissue defects. Harvesting a STSG creates an additional partial
thickness wound at the donor site which must be managed. Many dressings are commercially available for the management of STSG
donor sites; however, there is no evidence-based consensus on optimal dressing for site management. Urinary bladder matrix (UBM) is
an extracellular matrix that acts as a structural support for tissue remodeling and provides molecular components for repair. Common
clinical applications of UBM include coverage of deep wounds, burns, and irradiated skin. Skin grafting from the lower extremities poses
a challenge due to the increased dermal tension. UBM-based reconstruction is an alternative method of managing lower extremity skin
graft donor sites. This case study demonstrates the use of UBM in the reconstruction of a STSG donor site of the anterolateral thigh,
which resulted in satisfactory healing, no pain, and excellent cosmetic and functional outcomes.

Keywords: split-thickness skin graft donor site; dermal substitute; urinary bladder matrix

Introduction placement of a subcutaneous wound VAC. Plastic surgery was

consulted for skin grafting after serial debridements were com-
Large soft-tissue defects are traditionally treated with immediate
plete. The wound, which measured 4.4 × 14.1 cm and extended
full- or partial-thickness skin grafts [1]. Split-thickness skin graft-
to the level of the soleus muscle, was closed 3 days later with
ing (STSG), the process of separating a section of epidermis and
a 0.014-inch STSG harvested from the anterolateral left thigh in
dermis from the donor site and transplanting it to the recipient
one continuous piece. Epinephrine-soaked gauzed was applied to
site, is a commonly used reconstructive technique. Harvesting a
the donor site to aid with hemostasis and then the graft was
STSG creates an additional partial thickness wound at the donor
anchored to the wound edges circumferentially with interrupted
site which must be managed [2]. Donor site management is aimed
4-0 gut sutures. The graft was covered with a layer of nonadhering
at preventing morbidity, including pain, bleeding, infection, scar-
dressing, and a wound VAC was placed.
ring, decreased sensation, delayed healing, and poor cosmesis [1].
The left anterolateral thigh donor site (Fig. 1) was covered
Consequently, many products, such as mesh gauze or films, are
with a single 7 × 10 cm sheet of UBM (Acell Lafayette) (Fig. 2). A
traditionally used to cover the skin graft donor sites with hopes to
Tegaderm™ containing many small perforations created with a
improve wound outcomes. Hyalomatrix (Fidia Advanced Biopoly-
surgical scalpel was placed over the UBM, followed by Drawtex® ,
mers, Padua, Italy), a bilayered bioresorbable dermal substitute,
to wick away excess f luid. All components were then covered with
has recently been shown to minimize morbidity and improve
a large intact Tegaderm™ and the dressing remained in place for
donor site healing [1]. This case study demonstrates the use of
1 week (Figs 3–5).
urinary bladder matrix (UBM) (Acell Lafayette, IN), a different
The donor site dressing was removed 1 week postoperatively,
type of dermal substitute, in lower extremity STSG donor site
revealing a well-healing wound with no infectious signs or symp-
reconstruction.
toms (Fig. 6). The patient reported no pain at the site. The patient
was advised to apply Xeroform® and gauze pads to the donor
Case presentation site twice daily. One month postoperatively, the left thigh donor
A 35-year-old male diagnosed with necrotizing fasciitis of the right site demonstrated excellent healing with epithelized pale pink
lower extremity was transferred to our facility from a rural hos- tissues (Fig. 7). The patient was advised to continue to apply mois-
pital to undergo irrigation and debridement with intraoperative turizing ointment and dressings to the donor site. Two months

Received: August 15, 2023. Accepted: September 4, 2023

Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2023.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which
permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
2 | Bormann et al.

Figure 4. Intraoperative donor site covered with Drawtex® .

Figure 1. Intraoperative donor site following skin graft harvesting.

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Figure 5. Intraoperative skin graft donor site with dressings in place.

Figure 2. Intraoperative donor site covered with 7 × 10 cm UBM (Acell

Lafayette).

Figure 6. Healing donor site postoperative day 7.

Figure 7. One-month postoperative healing donor site.

Figure 3. Intraoperative donor site covered with perforated Tegaderm™. wounds. The dermis that remains facilitates healing of the
donor site and reepithelialization typically occurs within 7–14
days [3]. Proper management of STSG donor sites is critical to
postoperatively, the left thigh donor site and right lower extremity promoting healing while maximizing patient comfort and skin
skin graft site were well healed without complication (Fig. 8). cosmesis [2]. Many dressings are commercially available for the
management of STSG donor sites; however, there is no evidence-
based consensus on optimal dressing for site management [4].
Discussion In the absence of consensus on the best practice for STSG
STSG involves excising the epidermis and part of the dermis donor site management, additional products and techniques
to form a graft used for the coverage of a tissue defect caused have been developed in an attempt to facilitate donor site
by trauma, burns, surgical resection, and acute and chronic healing.
 UBM for STSG donor site | 3

Conclusion
This case study demonstrates that the use of UBM in the man-
agement of a STSG donor site results in excellent cosmetic and
functional outcomes.

Conflict of interest statement

None declared.

Funding
None declared.
Figure 8. Two-month postoperative healed donor site.

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