Bioactive Glass Matrix in Pressure Injuries: Early PAR & Closure

Bioactive Glass Fiber Matrix for Chronic Pressure Injuries: Early PAR & Closure Signals from a Case Series

TL;DR

Three chronic full-thickness pressure injuries (one Stage 3, two Stage 4) in older adults failed to heal with standard care. After borate-based bioactive glass fiber matrix (BBGFM) application and weekly follow-up, all achieved rapid first-week Percentage Area Reduction (PAR) (71–84%) and eventual closure. No infections or adverse reactions occurred.[1,2]

Why this matters

Chronic pressure injuries remain difficult to close due to inflammation, impaired angiogenesis, and extracellular matrix (ECM) disorganization.[4,5]

The borate-based bioactive glass matrix acts as an adjunctive therapy that may “jump-start” stalled wounds through ion-mediated angiogenesis and fibroblast activation.[1,12]

Study at a glance

(Patient with chronic injury, stage 4 second toe)

Design & setting

Case series from a wound care practice; three chronic pressure injuries (Stage 3 hip; Stage 4 sacrum; Stage 4 second toe). All had failed to close with standard care; one was unresponsive to prior cellular/tissue-based products (CTPs) and another had been complicated by infection.[4,7]

Intervention & cadence

Woundbed prep: Sharp debridement and standard preparation.[7,8]

Matrix application: Borate-based bioactive glass fiber matrix applied per manufacturer’s instructions and secured under appropriate secondary dressings.[3,14]

Follow‑up: Weekly assessment and retreatment.[3,7]

Outcomes measured

Primary: Week‑1 PAR.[9,10]

Secondary: Full epithelialization/closure, ongoing area reduction, adverse events.[1,11]

Results

Stage 4 toe: Week‑1 PAR 72%; closure by Day 28.[1,2]

Stage 3 hip: Week‑1 PAR 71%; closure by ~4 months.[1,2]

Stage 4 sacrum: Week‑1 PAR 84%; closure by ~4 months.[1,2]

No treatment-related adverse reactions or infections were observed.[3,14]

Why borate glass?

The matrix releases boron, sodium, potassium, magnesium, calcium, and phosphate ions—each associated with cell proliferation, neovascularization, and antimicrobial or host-modulating effects.[1,12]

Its bioactive structure supports fibroblast and keratinocyte migration and angiogenesis, helping transition chronic wounds out of inflammatory stasis.[1,6]

Practical guidance

Patient selection: Chronic Stage 3–4 pressure injuries not improving on standard of care (SOC) or prior CTPs, with controlled bioburden.[7,15]

Bed preparation: Sharp debridement → apply BBGFM → cover with moisture-balanced secondary dressing → weekly reassessment (aligned with WHS 2023 pressure injury protocols).[7,8]

What to track: Week‑1 PAR → serial % area reduction → granulation quality → edge advancement → infection signs.[9,16]

Limitations & next steps

This is a small n = 3 series without controls; comparative efficacy cannot be inferred. Still, the rapid early PAR and closure trajectory align with signals from controlled BBGFM trials in other chronic wound populations.[1,3]

Frequently asked

What is first‑week PAR and why does it matter?

PAR is Percentage Area Reduction between baseline and week 1: a simple, early signal that a therapy may be moving a chronic wound toward closure. In this series, PAR values of 71–84% were observed by week 1 alongside eventual closure, consistent with broader evidence that early PAR predicts longer-term healing probability.[9,11]

How often do you apply the matrix?

In the series, wounds were assessed and treated weekly after initial debridement and matrix placement under appropriate secondary dressings, a cadence similar to published BBGFM trials and manufacturer guidance.[3,14]

Were there any complications?

No adverse reactions or infections were observed during the monitored course of therapy in these three cases, aligning with RCT data showing low device-related infection risk with BBGFM.[1,14]

Bottom line

For chronic Stage 3–4 pressure injuries that plateau on standard care, borate-based bioactive glass fiber matrix offers a synthetic, biologically active scaffold that may accelerate early granulation and closure. The observed Week‑1 PAR >70% and complete epithelialization within months echo emerging evidence that ion-releasing bioactive glass matrices can reignite healing when conventional CTPs fall short, though larger controlled studies are needed to validate these early signals.[1,2]

References

1. 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:e70763. Wiley Online Library

2. 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

3. Armstrong DG, Zelen CM, Carter MJ, et al. A multi-centre, single-blinded randomised controlled clinical trial evaluating a bioactive glass microfiber wound matrix (Mirragen) versus collagen–alginate for diabetic foot ulcers. Wound Repair Regen. 2021;29(3):456–466. PMC

4. Bhattacharya S, Mishra RK. Pressure ulcers: current understanding and newer modalities of treatment. Indian J Plast Surg. 2015;48(1):4–16. PMC

5. Demidova-Rice TN, Hamblin MR, Herman IM. Acute and impaired wound healing: pathophysiology and current methods for drug delivery, part 1: normal and chronic wounds. Adv Skin Wound Care. 2012;25(7):304–314. PMC

6. Jin C, Shen J, Zeng Y, et al. Cellular and molecular mechanisms of wound repair. Cells. 2025;14(23):1850. MDPI

7. Gould LJ, Alderden J, Chaffee M, et al. WHS guidelines for the treatment of pressure ulcers—2023 update. Wound Repair Regen. 2024;32(1):1–38. Semantic Scholar

8. Visconti AJ, et al. Pressure injuries: prevention, evaluation, and management. Am Fam Physician. 2023;108(2):137–145. AAFP

9. Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Diabetes Care. 2003;26(6):1879–1882. PubMed

10. Coerper S, Beckert S, Küper MA, Jekov M, Königsrainer A. Fifty percent area reduction after 4 weeks of treatment is a reliable indicator for healing—analysis of a single-center cohort of 704 diabetic patients. J Diabetes Complications. 2009;23(1):49–53. ScienceDirect

11. Gwilym BL, Holloway S, Harding KG. A systematic review of diabetic foot and venous leg ulcers: predictive value of percentage area reduction for complete healing. Wound Repair Regen. 2023;31(2):183–195. Liebert Publications

12. Ege D, Deliormanlı AM, Boccaccini AR. Borate-based bioactive glasses (BBG): bone regeneration, wound healing and therapeutic potential. ACS Appl Bio Mater. 2022;5(8):3727–3759. ACS Publications

13. Mazumdar E, Dua A, Stone DH, et al. Percent area reduction as a surrogate to inform revascularization decisions in chronic limb-threatening ischemia. J Vasc Surg. 2022;75(5):1619–1628. Journal of Vascular Surgery

14. Engineered Tissue Solutions. Mirragen® Advanced Wound Matrix: product information and clinical evidence. Accessed December 1, 2025. Engineered Tissue Solutions

15. Pan Y, Yang Z, Fang C, et al. Advances in topical biomaterials and mechanisms for the treatment of pressure injuries. iScience. 2023;26(11):108232. Cell

16. Moore K, McCallion R, Searle RJ, et al. Prediction and monitoring of the therapeutic response of chronic dermal wounds. Br J Dermatol. 2006;155(6):1206–1213. PMC