Soft Tissue Remodeling in Infected Fields Using a Novel Extracellular Matrix: A Clinical Case Series Evaluation

Authors:
Cray Noah, Alexandra Smick, Meganoush Schmit, Frank Makhlouf, Latisha Stewart Smith, Isabel Lazo, Darin Saltzman

Body of Abstract:
Background:
Collagen-based extracellular matrices (ECMs) are widely used in regenerative medicine and have demonstrated benefit in complex wounds. Traditional ECMs, however, perform poorly in infected fields. This is especially true in cases of mesh infection and contaminated wounds, where microbial load inhibits healing. These scenarios carry high morbidity. Management of mesh infection often necessitates complete mesh explantation, a morbid and resource-intensive surgery. These challenges highlight the need for effective bioengineered solutions.

Multitissue platforms (MTPs) represent an emerging ECM technology designed to increase bioactive protein content relative to collagen alone, amplifying regenerative and immunomodulatory signaling. Xcellistem® Wound Powder, an MTP-based ECM developed by RTT Medical, provides a distinct advantage over conventional ECMs through its inherent antimicrobial activity. During degradation, Xcellistem releases matrix-specific peptides capable of directly killing bacteria, thereby reducing bioburden and enabling constructive remodeling even in culture-positive environments. This dual regenerative-and-antimicrobial mechanism positions Xcellistem as a uniquely suited solution for wounds involving infected mesh or complex contaminated wounds.

Methods:
We report a case series in five patients with complex contaminated wounds. Three patients presented with infected abdominal wall mesh, one had an enterocutaneous fistula, and one had a vulvar wound in previously irradiated tissue. Xcellistem was applied directly to the wound bed, with an overlying oil-emulsion sheet to serve as a non-adherent interface between dry dressings on top. The inner non-adherent layer was changed every 5-10 days, while the outer dry dressings were replaced every 24-48 hours. Wound appearance was sequentially monitored for healthy granulation tissue, epithelialization, and ultimate wound closure.

Results:
All three mesh-infection cases achieved complete healing without requiring mesh explantation surgery. The enterocutaneous fistula closed and its associated wound healed fully without operative intervention. The radiated vulvar wound demonstrated progressive granulation and ultimately healed completely. Across all cases, wound healing was steady and infection remained controlled. In contaminated or irradiated tissue, Xcellistem supported robust granulation and re-epithelialization.

Conclusions:
These early observations indicate that multitissue platform ECMs such as Xcellistem may offer a practical, non-surgical solution for wounds that traditionally fail to heal, including those in actively infected fields. By pairing regenerative bioactivity with inherent antimicrobial effects, Xcellistem demonstrated the ability to control infection and support durable tissue repair without operative intervention. This strategy may reduce mesh explantation rates and improve healing trajectories in high-risk and wounds. Larger, controlled trials are warranted.