Can An Emerging Extracellular Matrix Help Treat Acute And Chronic Diabetic Wounds?

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Valerie L. Schade, DPM, AACFAS

   The wound care sheets take four to 10 days for incorporation with the rate of resorption being dependent upon the thickness of wound care sheet. As the sheets resorb, they create a green to yellow or tan-colored film, and an odor. Do not remove this film as this is the normal course of resorption of the product. One should consider other secondary clinical signs of infection apart from appearance and odor of the wound to assess for the potential for infection. These signs include increased drainage, increased pain, induration, fluctuance or creptius about the periwound tissue. Another application of the product should occur when there is no more of the product or film from product resorption visible in the wound bed.

   One can use the product with and without antibiotic therapy, and in conjunction with other advanced wound care modalities such as non-contact low frequency ultrasound and negative pressure wound therapy.4,7

What A Recent Study Revealed

LeCheminant and colleagues published a retrospective review of the use of this extracellular matrix product on wounds on the lower extremity treated in an outpatient wound care center.4 The study consisted of a 12-month follow-up of 34 patients (26 male, eight female) with a mean age of 62.4 ± 13.4 years. Nineteen patients had diabetes. The types of ulcerations treated were plantar foot (10), anterior lower leg (six), venous leg (six), ischemic (three), decubitus (three), surgical wound dehiscence (six), amputation dehiscence (six), traumatic (one), traumatic laceration (one) and acute open fracture (one). All patients received the extracellular matrix product as either the initial treatment or after use of other advanced wound care modalities. The modalities included Prisma (Systagenix), Aquacel Ag (ConvaTec), Oasis Wound Matrix (Healthpoint Biotherapeutics), Dermagraft (Shire Regenerative Medicine), Apligraf (Organogenesis), Regranex (Healthpoint Biotherapeutics), Medihoney (Derma Sciences) and Integra (Integra LifeSciences).

   Clinicians applied the extracellular matrix product to wounds that had previous treatment with other products when they felt that wound healing had stalled for four weeks despite these treatments.4 The decision to use the extracellular matrix product as the initial treatment was arbitrary. All 34 patients achieved full wound healing at an average of 35.3 ± 47.7 weeks. Patients who received the extracellular matrix product as an initial treatment healed at an average of 6.3 ± 3.7 weeks in comparison to 11.7 ± 10.8 weeks in those who received prior advanced wound care treatments. The mean duration of wounds previously treated with other advanced wound care treatments was 25.5 ± 43.5 weeks.

   This study shows the capability of this extracellular matrix product to enhance wound closure both as an initial treatment and in wounds that have stalled in the face of other advanced wound care therapies.4

Case Study: When A Patient Presented With A Plantar Heel Ulceration And A Necrotizing Gas Gangrene Infection

A 56-year-old female with congestive heart failure, diabetes, atrial fibrillation, hypertension, chronic renal disease, a previous history of cerebrovascular accident, retinopathy and hyperlipidemia presented to the emergency room for chronic heart failure exacerbation. Doctors subsequently found the patient had a necrotizing gas gangrene infection related to a plantar heel pressure ulceration of the left foot.

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