Abstract : Background: Lower extremity amputations (LEAs) carry high rates of postoperative wound complications and reoperations, particularly among patients with significant comorbidities. Extracellular matrix (ECM) technologies have demonstrated promise in enhancing wound healing, and Multi-Tissue Platforms (MTPs) represent a newer generation of bioactive scaffolds designed to optimize tissue regeneration. This study evaluates the impact of an MTP-based wound powder (XCelliStem) on postoperative outcomes following below-knee (BKA) and above-knee (AKA) amputations.
Methods: A single-center retrospective analysis was conducted on 348 patients who underwent 449 major LEAs between January 2022 and September 2024. Forty-seven patients received XCelliStem powder during wound closure, while 301 patients (402 amputations) comprised the traditional cohort. Demographics, comorbidities, need for reoperation within six months, and requirements for local wound care were recorded. Application of XCelliStem was standardized across all cases.
Results: Reoperation occurred in 30.0% of the traditional cohort (94 BKAs; 27 AKAs) compared with 6.4% of the XCelliStem cohort (3 BKAs), representing a statistically significant reduction. The calculated number needed to treat (NNT) was 4.2, or 6.0 when excluding planned reoperations. Local wound care requirements did not differ significantly between groups (traditional: 19.6%; XCelliStem: 23%). No patient-selection bias or significant differences in comorbidity burden were identified between cohorts.
Conclusion: The use of an MTP-based ECM powder during LEA closure is associated with a significant reduction in reoperation rates, suggesting improved early wound healing outcomes. These findings support the incorporation of MTP technology as an adjunct to standard closure techniques. Further prospective studies are warranted to validate these results and evaluate outcomes within specific high-risk subgroups.

Keyword : Above-knee amputation, AKA, below-knee amputations, BKA, extracellular matrix, Lower extremity amputations, Multi-Tissue Platform, regenerative medicine, reoperation rates, wound healing, XcelliStem.