Biobrane in the management of critical microsurgical wounds of the upper extremity

Purpose: Evolving soft tissue necrosis and/or edema can complicate microsurgical reconstruction by leading to open wounds with exposure of critical structures: anastamosed vessels, nerves, and tendons. Not infrequently, primary closure of these wounds is not possible. Immediate skin grafting may lead to anatomical and/or functional failure of reconstructed structures, compromising immediate or long-term functional outcomes. In addition, local tissues are often unavailable, and free tissue transfer in those settings could be ill-advised, especially for small wounds. Methods: All of the senior author's microsurgical cases were reviewed. Four cases of replantation and one microsurgical reconstruction, where biologic dressings were used to treat critical wounds, were identified and are presented in this study along with an algorithm for the management of these types of wounds. Results: Biologic dressings are simple, effective, and reliable tools for intermediate treatment of critical microsurgical wounds. Flap or replant viability was preserved in 100% of cases without compromising functional results. Conclusions: Biologic dressings can be used safely to treat microsurgical wounds with exposed critical structures. This use of a biologic dressing greatly simplifies the management of these types of wounds, avoiding the need for complex surgical intervention.