Novel Porcine Xenograft as a Salvage Strategy for Lower Extremity Wound Reconstruction Following Free Flap Failure.

Background: Lower extremity wounds involving the proximal and middle tibia remain a reconstructive challenge, especially following free flap failure. Traditional salvage strategies are limited in patients with comorbidities or wound contamination. Porcine-derived xenografts, such as XCellistem, offer a biologically active scaffold to promote granulation tissue and enable secondary grafting. Methods: This case series included 2 male patients with complex tibial wounds and failed anterolateral thigh free flaps. Both underwent surgical debridement followed by multilayered application of the porcine xenograft XCellistem. Wounds were monitored for granulation tissue development and subsequently reconstructed using split-thickness skin grafts. Patients were followed up for at least 6 months to assess wound durability and limb function. Results: Both patients demonstrated successful granulation tissue formation, with one requiring serial applications. No major complications were observed, and both patients achieved stable wound coverage. Skin grafting was performed on postoperative day 16 and at week 12, respectively. Long-term follow-up confirmed durable healing and satisfactory functional outcomes. Conclusions: XCellistem porcine xenograft is a promising salvage option for lower extremity wounds after flap failure. It facilitates timely granulation, enables skin grafting, and may reduce the need for further microsurgical intervention. Larger studies are needed to validate these findings and expand limb salvage strategies.