Utility of porcine-derived xenograft as an adjunct to split-thickness skin grafting in lower-extremity wounds

Objective: Porcine-derived xenograft biological dressings (PXBDs) are occasionally used to prepare chronic wound beds for definitive closure before split-thickness skin grafts (STSGs). We sought to determine whether PXBD influences rate of STSG take in lower-extremity wounds. Methods: Lower-extremity wounds treated with STSGs were retrospectively reviewed. Patients were included in one of two groups: wound bed preparation with PXBD before STSG or no preparation. Patients were excluded if they received wound bed preparation via another method. Patient demographics, comorbidities, wound history, wound bed preparation, and 30-and 60-day outcomes were collected. Results: There was no difference in healing outcomes between the PXBD (n ¼ 27) and no preparation (n ¼ 39) groups. At 30-and 60-day follow-up, percentage of STSG take was not significantly different between groups (77.9% versus 79.0%, P₃₀ ¼ .818; 82.2% versus 80.9%, P₆₀ ¼ .422). Mean wound sizes at these follow-up periods were not different (4.4 cm² versus 5.1 cm², P₃₀ ¼ .902; 1.2 cm² versus 1.1 cm², P₆₀ ¼ .689). The PXBD group had a higher mean 6 SD hemoglobin A_1c level (8.3 6 3.5 versus 6.9 6 1.6; P ¼ .074) and age (64.9 6 12.8 years versus 56.3 6 11.9 years; P ¼ .007) versus the no preparation group. Conclusions: Application of PXBDs for wound bed preparation had no effect on wound healing compared with no wound bed preparation. The two groups varied only by mean age and hemoglobin A_1c level. The PXBD may be beneficial, but these results call for randomized controlled trials to determine the true impact of PXBDs on wound healing. In addition, PXBDs may have utility outside of clinically oriented outcomes, and future work should address patient-reported outcomes and pain scores with this adjunct.