Can An Emerging Extracellular Matrix Help Treat Acute And Chronic Diabetic Wounds?
- Volume 26 - Issue 2 - February 2013
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She went to the operating room for multiple serial debridements, which resulted in the loss of the entire plantar heel fat pad to the level of the calcaneus with skin loss extending to the medial and lateral aspects of the heel. Despite the location and depth of the wound, she received no treatment apart from topical gel thrombin and dry dressings for 10 days.
The patient’s care then transferred to the Limb Preservation Service. At this time, she received negative pressure wound therapy (NPWT). The wound was 10 cm x 6 cm x 1.5 cm with the calcaneus exposed at the plantar aspect of the wound. There was also a full thickness wound at the medial calcaneus that was 4 cm x 2 cm x 0.4 cm. A magnetic resonance image (MRI) at that time showed no evidence of calcaneal osteomyelitis. The NPWT continued and physicians applied a “kickstand” Delta frame external fixator to help offload the wound. Clinicians performed weekly dressing changes, utilizing NPWT as well as adjunctive application of Graftjacket (Kinetic Concepts Inc.) twice and Apligraf once prior to the utilization of the extracellular matrix product MatriStem.
Once clinicians began to use the extracellular matrix product, the wound reduced in size to 3.9 cm x 4.4 cm x 0 cm. There was also an increase in the thickness of the plantar tissue covering the heel. Due to the concern of potential calcaneal osteomyelitis, physicians expedited final wound closure with a partial calcanectomy and closure with a unilobar flap. Application of the extracellular matrix product led to a rapid decrease in wound size and increased plantar tissue thickness, making expedited surgical wound closure possible 16 weeks after the initial presentation and 14 weeks after the initiation of NPWT.
Dr. Schade is Chief of the Limb Preservation Service and Director of the Complex Lower Extremity Surgery and Research Fellowship at the Madigan Healthcare System in Tacoma, Wash. She is an Associate of the American College of Foot and Ankle Surgeons.
1. Sheehan P. Early change in wound area as a predictor of healing in diabetic foot ulcers: knowing “when to say when.” Plast Reconstr Surg. 2006; 117(7 Suppl):245S-247S.
2. Sheehan P, Jones P, Giurini JM, Caselli A, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robust predictor of complete healing in a 12-week prospective trial. Plast Reconstr Surg. 2006; 117(7 Suppl):239S-244S.
3. Langer A, Rogowski W. Systematic review of economic evaluations of human cell-derived wound care products for the treatment of venous leg and diabetic foot ulcers. BMC Health Serv Res. 2009; 9:115.
4. Lecheminant J, Field C. Porcine urinary bladder matrix: a retrospective study and establishment of protocol. J Wound Care. 2012; 21(10):476, 478-80, 482.
5. Brennan EP, Reing J, Chew D, et al. Antibacterial activity within degradation products of biological scaffolds composed of extracellular matrix. Tissue Eng. 2006; 12(10):2949-2955.
6. Mitchell KB, Gallagher JJ. Porcine bladder extracellular matrix for closure of a large defect in a burn contracture release. J Wound Care. 2012; 21(9):454-6.
7. Gonzalez J. Regenerative Medicine: Urinary Bladder Matrix Assistance with High Risk Diabetic Limb Salvage. Poster Presentation. http://www.acell.com/files/Gonzalez_Diabetic_Ulcer.pdf . Last Accessed 29 Dec 2012.