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

Valerie L. Schade, DPM, AACFAS

   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.

   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.

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