Management of infection-prone dehisced surgical wounds with adjunctive bovine-derived collagen matrix: a case series

Postoperative surgical wound dehiscence remains a challenging complication, particularly in lower extremity procedures where impaired perfusion, systemic comorbidities, mechanical stress from ambulation, and exposed deep structures increase susceptibility to delayed healing and infection. Collagen-based matrices are used adjunctively to standard of care (SoC) in complex wounds; however, evidence supporting their use specifically in postoperative dehiscence is limited. This small case series describes clinical outcomes in three high-risk patients with infection-prone dehisced lower extremity wounds managed with a bovine-derived collagen matrix (BDCM).

Patients with postoperative lower extremity wound dehiscence were managed with a BDCM following sharp debridement and SoC. Wound dimensions, granulation progression, re-epithelialisation and signs of infection were assessed at serial follow-up visits. The primary outcome was complete wound closure, defined as full re-epithelialisation without drainage or need for further surgical intervention. Secondary observations included changes in wound size over time, granulation and epithelial progression, as well as complications during the course of care.

All three patients achieved full wound closure during the observation period without documented complications or infection. Patient 1, with Achilles tendon exposure, demonstrated >80% wound volume reduction by day 17 and complete re-epithelialisation by day 40 following four collagen matrix applications. Patient 2, with a hard-to-heal (chronic) Chopart amputation wound with a 4.1cm tunnel, showed marked improvement after a single application, with >80% volume reduction by day 6 and resolution of the tunnelling component with approximately 99% volume reduction by day 27. Patient 3, with a dehisced lateral trans-metatarsal amputation stump wound and a dorsal foot eschar, and who had severe vascular and immunological compromise, demonstrated substantial early improvement by day 12 and >99% wound volume reduction by day 19, with complete re-epithelialisation documented at follow-up.

In this small case series, use of a BDCM adjunctive to SoC was associated with progression toward wound closure in infection-prone postoperative dehisced wounds, including those with tendon exposure, tunnelling and significant systemic comorbidities. These observations suggest that collagen-based matrices may serve as a useful adjunct when SoC alone is insufficient to support wound progression. Given the small sample size and absence of a comparator group, causal inferences regarding treatment efficacy cannot be made. Larger prospective studies are warranted to further evaluate the role of collagen matrices in the management of postoperative wound dehiscence.