Case report: treatment of a lower leg defect in the course of sarcoma with microvascular tissue

During normal wound healing, angiogenesis leads to re-establishment of a functioning microcirculation to deliver oxygen and nutrients required for clinically effective tissue repair. In refractory wounds, however, this process can be severely compromised due to insufficient vascularity and resulting senescent microenvironment.

This case report follows a patient undergoing aggressive chemotherapy and neoadjuvant radiotherapy who presented with a complicated 25 cm2 left leg wound and exposed tibial bone after failed skin grafting and advanced biologic treatment. PMVT, a structural microvascular tissue allograft, was selected to improve microvascular blood flow around this poorly vascularized and senescent irradiated environment. The initial clinical objective was to stabilize the wound during continued chemotherapy and bridge the time until tissue flap surgery. Despite ongoing treatment for sarcoma, 22 weeks after initial PMVT treatment, the wound had fully closed with thick epidermis covering the residual granulating part of the wound site.

Achieving wound healing with weekly PMVT treatment in this immunocompromised patient undergoing active chemotherapy, thus increasing quality of life without flap surgery, was unexpected. The use of PMVT to repair and reconstruct deficient microvascular tissue appeared to change the trajectory of healing and enhance the wound healing process.