ADM + NPWT for Open Fractures: 7-Case Series

Medical education note: For clinicians; not a substitute for patient-specific medical advice.

Clinician TL;DR

A single-surgeon retrospective series (2022–2025) from Rutgers New Jersey Medical School evaluated meshed human reticular acellular dermal matrix (HR-ADM) combined with negative pressure wound therapy (NPWT) for extremity wounds with periosteal stripping/exposed bone after open fractures and other severe injuries. Among 7 patients (mean age 57; 86% lower extremity; wounds 6–700 cm², median 48 cm²; 86% traumatic; 71% infected), all developed healthy granulation tissue over HR-ADM; 4 proceeded to split-thickness skin grafting (STSG) and 6/7 wounds (86%) were documented closed at follow-up.

Why This Matters

57-year-old patient with chronic lower extremity wound, initial visit.

Open-fracture soft-tissue loss—especially with periosteal stripping—often pushes teams toward flap reconstruction, yet many patients are poor flap candidates due to comorbidities, contamination, or resource constraints. Aseptically processed, meshed HR-ADM offers an open scaffold for host ingrowth and revascularization; when paired with NPWT, it can create a graft-ready bed or support secondary closure in select cases—offering a less-invasive, staged alternative to immediate flap surgery.

What the Rutgers Series Did and Found

Design & Setting

Single-surgeon, retrospective chart review (2022–2025) of extremity wounds with periosteal stripping treated with meshed HR-ADM + NPWT; endpoints included granulation presence, receipt of STSG, and wound closure.

Population Snapshot

• n = 7; mean age 57; 57% male
• 86% lower-extremity wounds
• Wound area 6–700 cm² (median 48 cm²)
• 86% traumatic; 71% infected at presentation

Outcomes

57-year-old patient post-op with healthy granulation tissue.

• Healthy granulation documented in all wounds after HR-ADM application
• STSG performed in 4/7 (57%)
• Closure achieved in 6/7 (86%), including 2 that closed without grafting

The Staged Pathway

1. Debridement to a clean, bleeding bed; treat infection early.
2. Apply meshed HR-ADM over exposed structures.
3. Add NPWT to secure the matrix and manage the interface.
4. Reassess for granulation; proceed to STSG once graft-ready—or continue toward secondary intention if progressing.

When to Consider HR-ADM + NPWT

• Open fractures with periosteal stripping/exposed bone where flap is contraindicated or delayed.
• Infected or contaminated wounds after adequate source control and debridement.
• Large surface-area defects where a granulation scaffold can reduce reconstructive complexity or stage toward STSG.

Practical Protocol You Can Adapt

Bed Prep & Infection Control

Serial, aggressive debridement, culture-guided therapy, and meticulous hemostasis before matrix application.

Matrix Placement

Lay meshed HR-ADM to maximize contact with viable tissue; conform to voids/edges.

NPWT Over the Matrix

Use NPWT dressings to maintain uniform pressure and moisture balance.

Decision Point at Granulation

• If bed is robust and uniform → STSG (done in 57% of patients in this series).
• If epithelialization is advancing → consider continued secondary intention (achieved closure in some cases).

Limitations

Small case series (n = 7), single surgeon, and variable follow-up—no comparator arm, cost analysis, or standardized NPWT parameters reported. Authors call for larger, prospective studies.

Bottom Line

When flap options are limited, meshed HR-ADM + NPWT can bridge exposed bone to a graft-ready bed and standardize staged closure in carefully selected open-fracture wounds.

References

1. Single-surgeon retrospective series (Rutgers NJMS, 2022–2025).
2. Dolivo D, et al. Decellularized human reticular allograft dermal matrix in diabetic murine wound model. Cytotherapy. 2021.
3. Iorio ML, et al. ADM use in upper and lower extremity wounds. Plast Reconstr Surg. 2012.