Sharon Grason, PhD, RN
Trauma centers range from level I (most comprehensive) to level V (basic care). Level I centers, typically in urban areas, have full specialist coverage, advanced equipment, and research programs. In contrast, level II and below are often resource limited and located in community hospital settings, rural or semi-rural areas, with fewer specialists, limited surgical and diagnostic capacity, and a focus on stabilizing patients before they transfer to higher-level care.
As a nurse who spent many years in a level II trauma center, I’ve navigated the tension of treating complex wounds under constrained resources. Orthopedic trauma with exposed bone or tendon is common, often resulting from machinery accidents, falls, and high-impact injuries. These injuries demand specialized care, but the reality for many centers is that they have limited operating room (OR) access, scarce specialist coverage, and the peril of prolonged transport. The wounds are not just clinically challenging; they are logistical puzzles.
The core challenge: Avascular wound beds and resource gaps
Skin grafts are prone to failure when placed over inadequately prepared wound beds, particularly on exposed tendon or bone. While flap surgery offers a reliable alternative, it often demands resources and expertise that may surpass a hospital’s capabilities.
- OR time bottlenecks create delayed coverage, increasing infection/desiccation risk
- Specialist-dependent workflows can disrupt continuity
- Patient burdens (donor sites, rehab) can strain recovery
Options are needed that protect immediately, build progressively, and support timely definitive closure without demanding level I resources.
The right dermal matrix: What matters for level II trauma
Cohealyx® is an absorbent, porous matrix engineered from purified collagen derived from bovine dermal tissue. It offers significant economic advantages in wound management, including supporting revascularization/wound bed readiness as early as day 7, thereby reducing infection risk.1
Cohealyx brings several advantages to level II trauma centers, physicians, and their patients:
Bridges the avascular gap
Unlike traditional skin grafts, which require a well-vascularized bed of granulation tissue for survival, Cohealyx is uniquely suited for application directly on avascular structures like exposed tendon or bone. This critical difference eliminates the waiting period often necessary to cultivate a viable wound bed. By serving as a bioactive scaffold, Cohealyx can be applied during the initial debridement, providing immediate biological coverage that protects the wound from contamination and desiccation.
Simultaneously, it facilitates the inward migration of the patient’s own cells and capillaries, actively guiding the development of new, vascularized tissue directly over these challenging surfaces. This process effectively transforms an avascular wound bed into a graft-ready environment, all within a single, integrated healing timeline.
Reduces OR burden
Cohealyx application occurs during initial debridement and supports staged split-thickness skin grafts instead of complex flaps.1
Patient-focused
Cohealyx avoids the transfer/logistics of flap surgery. It supports rapid vascularization and autograft readiness, reducing the use of inpatient stay resources.
The verdict: A pragmatic approach
Cohealyx is not a panacea. Flaps and other matrices are more appropriate in some situations. But its ability to be applied across multiple wound types and efficiency at preparing a wound bed for autografting make it a strategic ally for all level centers – especially so for level II and below, which may be resource constrained.1 Cohealyx helps transform high-resource problems into manageable procedures, potentially preserving limbs and resources.
In trauma, time is tissue. Solutions must fit the ecosystem we work in.
– Sharon grason, phd, rn
Looking for more like this? Read Enhance Traumatic Wound Management with a Two-Stage Dermal Matrix and Autologous Skin Cell Therapy Approach or learn more about Cohealyx collagen dermal matrix.
About the author
Sharon Grason, PhD, RN is a seasoned nurse with 28 years of experience in trauma, OR, and hospital leadership, as well as nursing education. She currently serves as Director of Medical Education at AVITA Medical, blending clinical expertise with academic and hospital leadership to advance healthcare training and innovation.
References: 1. Bush KA et al. Cureus. 2025;17(3):e81517.
