Abstract:Soft tissue defects with exposed tendons present unique challenges in surgical reconstruction, as tendons are vulnerable to desiccation, infection, and necrosis. We present a single-center, retrospective case series of 10 patients with exposed tendons who underwent surgical reconstruction with ovine forestomach matrix (OFM) grafts. Medical records were reviewed to establish patient demographics, co-morbidities, injury characteristics, and post-operative outcomes. OFM grafts were applied for staged reconstruction, for closure via secondary intention, as implants with primary closure or fasciocutaneous flaps, and as a circumferential tendon-protective layer. The median time to granulation tissue coverage was 3 weeks (IQR: 2, 4), and to full epithelialization 4 weeks (IQR: 1, 6). The median follow-up period was 29 weeks (IQR: 6, 61). Long-term assessments evaluated tissue pliability and active range of motion. Overall, OFM provided good surgical utility, promoting rapid coverage, wound closure, and favorable functional outcomes in complex tendon exposure cases.