Three-dimensional solution for deep and tunneling wounds

Abdominal Surgical Dehiscence Post Panniculectomy With Miro3D Applied to Wound

Clinical Overview and History

Female patient who underwent a panniculectomy surgery in May 2022.

Initial Findings

Approximately two and half months later, the patient presented with an abdominal surgical wound dehiscence. The wound measured 8cm x 2cm x 0.5cm in depth with 2cm of medial tunneling.

A wound VAC was applied. The wound VAC dressing was disrupted and not repositioned which resulted in superficial skin breakdown on the superior part of the wound opening. The VAC was removed by the patient before the two week follow-up visit.

Treatment

Two weeks later, and because of the discontinued use of the wound VAC by the patient, the main wound measured 9cm x 2.7cm x 2cm in depth with 2.5cm of medial tunneling (Figure 1). Miro3D (5cm x 5cm x 2cm size) was applied to the tunneling space and the main body wound (Figure 2). The Miro3D was covered with Mepitel® dressing and secured with an ABD dressing. The patient was instructed to perform daily outer dressing changes and Vashe® wound solution rinses to keep the wound clean. A wound VAC was not reapplied.

Seven days following the initial placement of Miro3D, the wound measured 7.5cm x 2.5cm x 0.5cm in depth with no tunneling (Figure 3). The Miro3D was resorbed into the wound bed. Daily wet to dry dressing changes were initiated.

Three days later, the patient returned for a second application (Figure 4). A 5cm x 5cm x 2cm Miro3D was reapplied to the wound.

Four days after the second placement of Miro3D, the wound measured 7.25cm x 1.25cm x 0.5cm deep and Miro3D was noted as fully resorbed within the wound bed (Figure 5). The wound was washed with a wound solution and covered with a dry dressing. The patient was instructed to perform daily Vashe washes with dry dressing changes. The patient returned for follow-up appointments every one to three weeks as transportation resources allowed.

By day 54, following the second placement of Miro3D, the wound measured 2cm x 1cm x 0.4cm (Figure 6).

77 days from the second placement of Miro3D, observations of the wound included a significant reduction in size and continued wound healing (Figure 7).
On day 98, the wound measured 0.4cm x 0.4cm x 0.2cm (Figure 8).

Conclusion and Post Procedure

Full wound healing was observed in January 2023, which was 127 days from the initial Miro3D application to the wound (Figure 9).

Summary

In this case, the ability to cut and shape Miro3D to conform to the wound bed for full wound wall apposition in both the tunneling space and main wound bed was beneficial. Miro3D demonstrated volume replacement by quickly eliminating the initial tunneling area as well as reducing the size of the wound with the protection of the collagen scaffold. Full healing was achieved 127 days following the placement of Miro3D.

Physician Information

Moses K. Shieh, DO, FACOS, Medical Director & Founder of Surgical Healing Arts Center in Fort Myers, FL
Specializes in Advanced Laparoscopic Bariatric Surgery and General Surgery. Surgical Director of Robotic Surgery at Gulf Coast Medical Center (part of the Lee Health System) in Fort Myers and currently serves as a member of the Medical Executive committee. Wound Director for Landmark Hospital in Naples.

Stage IV Pressure Ulcer of Sacral Region

Wound: 10cm x 5cm x 1.5cm Miro3D used = 5cm x 5cm x 2cm	Post – Day 7 No reapplication	Post – Day 9 Reapplication of Miro3D	Post – Day 12	Post – Day 19