(CS-080) Use of Borate-Based Bioactive Glass Fiber Matrix for a Chronic Non-Healing Dorsal Foot Ulcer with Exposed Tendon and Hardware: A Case Report

Introduction: Chronic non-healing wounds, particularly those with exposed tendon or hardware,
present a formidable clinical challenge. Surgical site dehiscence following joint fusion,
especially in elderly patients, often results in prolonged wound care and risk of infection
or hardware failure. Bioactive glass materials have shown promise in facilitating
angiogenesis and tissue regeneration.1-3 We report a case of a 69-year-old female smoker
with a chronic dorsal foot ulcer overlying a first metatarsophalangeal (MTP) joint fusion
site that occurred after a fall, complicated by exposed tendon/hardware and removal,
that demonstrated significant healing following application of borate-based bioactive
glass fiber matrix (BBGFM)

Methods: The patient initially presented for a first metatarsal joint fusion on 9/20/2024. The
surgical site dehisced following a fall which was later complicated by exposed tendon
and hardware necessitating removal on 1/31/2025. Prior therapies included a synthetic
bovine matrix, amniotic membrane, and wound vacuum assisted closure (VAC), with
minimal sustained improvement complicated by poor compliance. The wound measured
9.0cm3 following surgical site dehiscence. On 02/12/2025, BBGFM was introduced
following the hardware removal. The wound was evaluated at regular intervals through
wound closure on 4/14/2025

Results: The wound volume decreased from 9 cm³ to 0.75 cm³ and remained stable through
early January. In March 2025, intermittent setbacks occurred following a required
surgical hardware removal. The first application of the borate-based bioactive glass
fiber matrix (BBGFM) was introduced on 02/12/2025, resulting in rapid granulation
tissue formation despite exposed tendon. Complete wound closure was achieved after
three total applications, with final closure documented on 04/14/2025

Discussion: This case highlights the potential of BBGFM in managing complex post-surgical
wounds with exposed deep structures. The extracellular matrix like structure may have
contributed to both angiogenesis as well as an environment that may facilitate fibroblast
activity , facilitating tissue regeneration. While intermittent setbacks occurred, overall
healing was substantial, supporting further use of BBGFM as an adjunctive treatment
in wound care. This synthetic fiber may be especially useful in elderly patients where
wound healing is compromised, and when exposed bone or hardware precludes the use of
traditional dressings