ORIGINAL RESEARCH article
Front. Surg.
Sec. Reconstructive and Plastic Surgery
This article is part of the Research TopicSurgical Innovations in the Management of Chronic WoundsView all 7 articles
Surgical Management of Stage 3 and 4 Pressure Injuries in Trauma Patients Using Ovine Forestomach Matrix Grafts: A Prospective Case Series
Provisionally accepted
Sophia M. TrinhKaitlyn Andre
Ada Irmak ÖZCANDhanushka S. VitharanaPaige E. DevilleJoseph W. MasonJohn P. Hunt
Alan B. Marr
Patrick GreiffensteinLance E. Stuke
Alison Smith*- School of Medicine, Louisiana State University, New Orleans, United States
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract Introduction: Stage 3 and 4 pressure injuries (PIs) pose a significant challenge, particularly in trauma patients. Surgical management aims to support improvements in tissue vitality and often relies on debridement and negative pressure wound therapy. The use of ovine forestomach matrix (OFM)-based grafts to augment existing surgical approaches may improve tissue quality prior to reconstruction or closure by secondary intention. Methods: This prospective study is part of a larger Institutional Review Board-approved study (Registry: ClinicalTrials.gov. Clinical trial number: NCT05243966). The study enrolled patients with Stage 3 and 4 PIs between July 2022 and July 2024 at a single Level 1 trauma center. The primary study endpoint was the incidence of post-operative complications and secondary endpoints included time to granulation tissue coverage and/or fill, percent area reduction, and number of OFM applications. Results: Nine participants (eight males, one female) with a total of twelve PIs (25% Stage 3 and 75% Stage IV) were enrolled in the study. The mean surface area was 46±24 cm2 and 10 of the 12 enrolled PIs included areas of tunnelling and/or undermining. The median time to 50% granulation tissue was 2.0 (IQR: 1.5, 8.5) weeks, and the median time to complete granulation tissue coverage was 6.5 (IQR: 2.0, 15.0) weeks. Tunneling and/or undermining was eradicated in 50% of PIs. The mean percent area reduction at the last recorded visit was 61±30%. There were no post-operative complications. Conclusion: These results suggest that OFM-based grafts may serve as a valuable adjunct for the surgical management of late-stage PIs that are clinically challenging to progress towards healing.
Keywords: ovine forestomach matrix, Pressure injury, Surgical reconstruction, Trauma, Wound Healing
Received: 13 Sep 2025; Accepted: 13 Feb 2026.
Copyright: © 2026 Trinh, Andre, ÖZCAN, Vitharana, Deville, Mason, Hunt, Marr, Greiffenstein, Stuke and Smith. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Alison Smith
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.