Use of Ovine Forestomach Matrix in the Treatment of Facial Thermal Burns

Rami H. Al Mousa, MD; Brandon A. Bosque, DPM; Shane G. Dowling, PA-C


Wounds. 2022;34(4):e17-e21. 

In This Article

Abstract and Introduction


Introduction: Thermal burn injuries are common, devastating medical emergencies that are challenging to manage. Timely and effective treatment is paramount to both short- and long-term patient outcomes. Currently, medical providers and health care facilities worldwide are emphasizing the need for cost-efficient and accessible treatments; such treatments are particularly vital for vulnerable populations with limited access to advanced medical resources. The use of extracellular matrix (ECM) technologies has become widespread in the management of acute and chronic wounds, including burns. Ovine forestomach matrix (OFM) is an ECM bioscaffold isolated from sheep forestomach tissue and has been shown to be effective in soft tissue reconstruction procedures.

Case Report: The use of OFM in the treatment of 2 facial thermal burn injuries, including in a pediatric patient, is described. Both patients fully recovered from their facial injuries with satisfactory cosmetic outcomes.

Conclusions: Although OFM technology is widely used in the management of acute and chronic wounds, the authors believe this to be the first published report of its use to aid healing in burns. Ovine forestomach matrix may provide a valuable additional tool for the management of complex burns.


Soft tissue defects secondary to burn injuries can be devastating and difficult to treat. The incidence of facial burns varies by country but has been reported to range between 27% and 60%.[1] These facial burn injuries are often extremely painful and prone to infection, and acceptable cosmetic outcomes are critical for the patient.[2] Even if a burn injury progresses to complete closure, concern remains for the longer-lasting sequelae, such as chronic nerve pain, disfigurement, painful fibrotic scar, loss of function, loss of sensation, and psychosocial implications for the patient.[1,3,4] Although the skin of the face tends to be more vascularized than peripheral anatomy, facial burns pose a treatment challenge for multiple reasons. Skin contracture is common in areas of the face with underlying mobile tissues, whereas the forehead is at increased risk of exposed bone and the associated challenges of achieving adequate coverage.[5] Eyelids and lips are thinner tissues and thus are particularly prone to contracture.[5] Facial burns are also difficult to manage due to airway management, the potential for respiratory compromise resulting from thermal inhalation injury, or postinjury edema.

Ovine forestomach matrix (OFM) is a decellularized extracellular matrix (ECM) bioscaffold that has been used extensively in the management of complex wounds and soft tissue reconstructions, including chronic lower extremity wounds and acute surgical wounds.[6–12] The process of tissue decellularization of the intact ovine tissues removes all cells and cellular debris, leaving an intact, native, and biocompatible scaffold for use in soft tissue regeneration applications.[13] Ovine forestomach matrix contains naturally occurring anti-inflammatory proteins[14] and demonstrates anti-inflammatory properties in vitro and in vivo,[15,16] stimulates blood vessel formation,[17] and is remodeled into functional soft tissue over time.[17,18] The structure of OFM is biomimetic of native soft tissue ECM and serves as a scaffold for fibroblast and keratinocyte migration and proliferation.[13] A proteomic analysis of OFM identified more than 150 known ECM and ECM-associated proteins, including various growth factors (eg, epidermal growth factor, platelet-derived growth factor) and antibacterial proteins, including cathelicidin and β-defensin.[14]

Although the use of OFM in managing chronic wounds has been widely published, few reports describe its use in the treatment of burns. This case report documents the successful use of OFM to treat 2 patients with challenging facial thermal burns. The authors obtained patient or guardian consent to publish the case photos and data.