Bioactive Glass Matrix for Complex Leg Wounds: Results & Protocol
Borate‑Based Bioactive Glass Fibrous Matrix for Complex Lower‑Extremity Wounds: 4‑Case Series, Practical Protocol, and Evidence Round‑Up
Medical education note: This article is for clinicians and is not a substitute for patient‑specific medical advice.
Quick take
A clinician case series using a borate-based bioactive glass fibrous matrix (BBGFM) on four difficult lower-extremity wounds (PG, VLU with hematoma, necrotizing fasciitis post-debridement, and a Wagner 3 DFU) reported substantial percent-area reduction (PAR) across all cases and complete closure in the DFU—after standard care had failed. Applications ranged from one to seven, over 5–13 weeks, with PAR from 70.96% to 100%. [11]
Mechanistically, borate-based bioactive glass can modulate the wound microenvironment, shows broad in‑vitro antimicrobial activity against wound‑relevant pathogens, and can stimulate VEGF under dynamic flow—supporting angiogenesis and tissue regeneration. [4,5]
Study at a glance
Design & setting. Four patients with complex lower‑extremity wounds received BBGFM as an adjunct to standard care. Primary endpoint: percent area reduction (PAR). Cases:
Pyoderma gangrenosum (PG), right leg—chronic full‑thickness wound, previously unresponsive to ovine forestomach matrix.
Venous leg ulcer with hematoma (VLU/ESRD), left leg—non‑ambulatory patient.
Necrotizing fasciitis, left leg—surgically debrided; previously unresponsive to NPWT.
Wagner 3 diabetic foot ulcer (DFU), left heel—~1 year chronicity; unresponsive to HBOT.
Results.
PG: 7 applications over ~13 weeks → 70.96% PAR.
VLU/hematoma: 1 application over ~11 weeks → 92.46% PAR.
Necrotizing fasciitis: 1 application over ~7 weeks → 90.16% PAR.
DFU: 2 applications over ~5 weeks → 100% PAR (full closure).
Follow‑up intervals and change frequency were individualized to clinical response.
Interpretation. BBGFM functioned as a bioactive skin-substitute scaffold across inflammatory (PG), vascular (VLU), infectious (post‑NF), and diabetic wounds. The complete DFU closure underscores its potential as an adjunct in high-risk, previously non‑healing wounds. [2,3]
Limitations: Small, uncontrolled series; outcomes are hypothesis-generating and should be validated in larger, comparative trials. [1,2]
Why borate‑based bioactive glass?
Antimicrobial support: A 2023 in‑vitro study showed BBG matrices reduced a broad panel of 19 wound‑relevant pathogens for up to 7 days, suggesting barrier and bioburden benefits in the early phase of care. [4]
Pro‑angiogenic signaling: Borate-based glass fibers stimulate VEGF under dynamic flow conditions—consistent with microvascular support critical for chronic legs and heels. [5]
Soft‑tissue compatibility: Reviews highlight expanding soft‑tissue applications for bioactive glasses beyond bone—leveraging ion release, pH effects, and scaffold architecture to reboot stalled repair. [6,7]
Clinical momentum: A multicenter RCT compared a resorbable glass microfiber matrix to collagen–alginate in DFUs, supporting superior outcomes with the glass matrix at 12 weeks (healing and/or PAR endpoints). [1,2]
How to use BBGFM (practical protocol)
How to use BBGFM (practical protocol)
1) Prepare the bed
Perform sharp debridement to a bleeding surface; address infection per standard of care. [9]
Optimize offloading (DFU/heel) or compression (VLU) when arterial supply allows. [9,10]
2) Place the matrix
Fill and cover the defect with the fibrous matrix; ensure uniform contact. [3,10]
Moisten with sterile saline per IFU to initiate handling and conformability. [10]
3) Dress & maintain
Use a moisture-balanced secondary dressing; set change intervals to wound status (the series used 1–7 applications over 5–13 weeks). [10,11]
Reassess weekly to biweekly; track PAR to verify trajectory. [9,11]
4) Combine thoughtfully
Continue standard care (e.g., edema control, glycemic management). BBGFM in the series was adjunctive, not a replacement for SOC. [1,9]
Where it fits in your algorithm
Reassess at 4–6 weeks of SOC. If stalled, consider BBGFM for:
Venous ulcers with persistent exudate/hematoma. [1,8]
Postinfectious cavities after nec fasc debridement. [3,8]
Neuropathic DFUs with chronicity despite HBOT/advanced dressings. [1,2]
Pair with fundamentals: offloading/compression, infection control, glycemic optimization. [9]
Measure and document PAR; escalate/adjunct (e.g., NPWT, grafts) if trajectory is suboptimal. [9]
FAQs
Is bioactive glass “antimicrobial”?
In vitro, borate-based glass matrices demonstrated sustained reductions in multiple wound pathogens for up to a week; clinical anti‑infective benefits should be inferred cautiously and paired with standard infection management. [4,8]
How fast should I expect results?
In the case series, substantial PAR occurred over 5–13 weeks, with complete closure in a chronic DFU at 5 weeks after two applications—but individual results vary with perfusion, pressure, and bioburden. [2,11]
What wounds are good candidates?
Refractory DFUs, VLUs, postinfectious cavities after adequate debridement, and select inflammatory ulcers (PG) under specialist care. Always ensure arterial sufficiency and systemic optimization. [1,3]
Bottom line
For refractory lower-extremity wounds—including DFU, VLU, PG, and post‑NF defects—a borate-based bioactive glass fibrous matrix can be a useful adjunct to standard care. In a small series, all cases improved substantially by PAR, and a chronic DFU closed completely within five weeks after two applications. Pair BBGFM with meticulous debridement, perfusion/pressure optimization, and close follow-up—and track PAR to confirm progress and justify next steps. [2,11]
References
1.Armstrong DG, Orgill DP, Galiano RD, et al. A multi-centre, single-blinded randomised controlled clinical trial evaluating the effect of a resorbable glass microfiber matrix in the treatment of diabetic foot ulcers. Int Wound J. 2021;18(4):402‑412 (approx.). PubMed
2.Armstrong DG, Orgill DP, Galiano RD, et al. A borate-based bioactive glass advances wound healing in non-healing Wagner grade 1 diabetic foot ulcers: a randomised controlled clinical trial. Int Wound J. 2025;22(10):e70763. PMC
3.Buck DW II. Innovative bioactive glass fiber technology accelerates wound healing and minimizes costs: a case series. Adv Skin Wound Care. 2020;33(8):1‑6. Lippincott Journals
4.Jung S, et al. Antimicrobial effects of a borate-based bioactive glass wound matrix on wound-relevant pathogens. J Wound Care. 2023;32(12):763‑772. sawcs2024posters.eventscribe.net
5.Chen S, et al. In vitro stimulation of vascular endothelial growth factor by borate-based glass fibers under dynamic flow conditions. Mater Sci Eng C. 2017;73:495‑505. See also: Chen S. In vitro study of wound-healing capabilities of bioactive glass fibers under various culture conditions. MSc thesis, Missouri University of Science and Technology; 2015. Scholars' Mine
6.Ege D, Deliormanlı AM, Boccaccini AR. Borate bioactive glasses (BBG): bone regeneration, wound healing and angiogenesis. ACS Appl Bio Mater. 2022;5(8):3532‑3549. ACS Publications
7.Negut I, Ristoscu C, Grumezescu V. Bioactive glasses for soft and hard tissue healing. Appl Sci. 2023;13(10):6151; and Ren Z, et al. Bioactive glasses: advancing skin tissue repair through multi-scale mechanisms. Biomed Mater Res. 2025; e0134. MDPI
8.Naseri S, Lepry WC, Nazhat SN. Bioactive glasses in wound healing: hope or hype? J Mater Chem B. 2017;5(30):6167‑6179. RSC Publishing
9.Sibbald RG, et al. Wound bed preparation 2021. Adv Skin Wound Care. 2021;34(4):183‑195; and Chen P, et al. IWGDF guideline on interventions to enhance healing of foot ulcers in persons with diabetes. Diabetes Metab Res Rev. 2024;40(1):e3644. OUP Academic
10.ETS Wound Care. MIRRAGEN® Advanced Wound Matrix: Instructions for Use and product overview. Engineered Tissue Solutions; accessed 2025 (includes guidance on debridement, moist wound environment, and secondary dressings). WoundSource
11.Medipyxis Clinical Data. Four-case series of borate-based bioactive glass fibrous matrix (BBGFM) for complex lower-extremity wounds (pyoderma gangrenosum, venous leg ulcer with hematoma, post‑necrotizing fasciitis, and Wagner 3 diabetic foot ulcer). Medipyxis.com; 2025 (unpublished observational series).
