Abstract
Purpose: This case series examines the feasibility and outcomes of using a multi-tissue extracellular matrix (ECM) powder as an adjunct to standard wound care in a conflict zone. Primary objectives were granulation by day 7, wound closure, and minimizing early complications among patients with complex ballistic and blast injuries in Gaza during the 2024 Israeli military offensive. Methods: A retrospective observational study was conducted at the European Gaza Hospital from April to June 2024. Fifteen patients with high-energy soft tissue injuries who received ECM powder (XCellistem™) after surgical debridement were included. Data were extracted from operative reports, wound documentation, and clinical follow-up. Outcomes included granulation by day 7, wound closure method, and complications such as infection or dehiscence. Results: All 15 patients (median age 28; 14 male) sustained severe trauma, with 80% having exposed bone or tendon. ECM was applied directly to wound beds and often co-applied with vancomycin. Granulation tissue was observed in 12 patients by day 7, and 13 achieved wound closure via grafting, flap coverage, or secondary intention. No adverse reactions to ECM were reported. Conclusions: Multi-tissue ECM powder seems feasible and safe under austere conditions and appeared to support wound healing in severely injured patients. Its shelf stability, ease of use, and regenerative potential make it a promising adjunct for surgical care in resource-constrained conflict zones.