A Closer Look At Acellular Dermal Matrices For Chronic Diabetic Foot Ulcers

Andrew H. Rice, DPM, FACFAS, and Mallory Przbylski, DPM

   We opened an acellular dermal allograft (4 cm x 8 cm x 0.4 mm) from sterile packing and placed it in sterile saline solution for rehydration. After rehydrating the graft, we placed it over the entire wound and sutured the graft with Prolene 5-0 suture. We subsequently employed negative pressure wound therapy (NPWT) (VAC therapy, KCI) at 125 mmHg.

   The patient was subsequently discharged from the hospital and returned to the extended care facility. At day five, clinicians removed VAC therapy and placed a thin layer of oil emergent gauze and a 4 x 4 felt with mineral oil over the wound surface. Daily dressing changes with oil emergent gauze and saline-soaked, mineral oil took place over the postoperative course. The patient’s wound was healed at day 90.

Case Study: Addressing Delayed Healing Of A Fifth Ray Amputation Site

A 62-year-old male patient presented with a history of type 2 diabetes mellitus and peripheral vascular disease. He had a peripheral artery bypass graft of the right lower extremity and subsequent amputation of the right fifth ray for wet gangrene. We noted delayed healing of the right fifth ray amputation site.

   We brought the patient to the operating room. After providing local anesthesia with intravenous sedation, we debrided the superficial surface of the wound with the Versajet (Smith and Nephew) hydrojet debridement tool. After irrigating the graft application site with sterile saline solution, we placed a 4 cm x 4 cm x 0.40 cm TenSIX sterile acellular dermal allograft over the wound surface. Utilizing 2-0 Prolene simple interrupted sutures, we sutured the graft around the wound periphery with 2 mm overlap. We subsequently applied VAC therapy.

   At five days post-op, clinicians removed VAC therapy. We placed Adaptic (Systagenix Wound Management) oil emergent gauze over the wound surface and the patient had daily dressing changes. We noted rapid in-growth of granulation tissue into the wound surface followed by rapid epithelial coverage. The graft site was healed at 20 days after application of the TenSIX allograft. The patient subsequently wore athletic shoes and returned to work.

Final Notes

In conclusion, the goal of the podiatric surgeon is limb salvage and there are a variety of wound care products available to aid in this task. Allografts present a viable option for rapid healing of chronic DFUs. Human-derived acellular dermal matrices create a minimal inflammatory response with a decreased risk of rejection.4,6

   The TenSIX human-derived acellular dermal matrix product provides a sterile scaffolding to allow for rapid vascular ingrowth and epithelialization while reducing the risk of rejection and infectious complications in the typical immunocompromised patient with chronic non-healing DFUs.

   Dr. Rice is an Assistant Clinical Professor in the Department of Orthopaedics and Rehabilitation at the Yale University School of Medicine. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Pryzbylski is a second-year podiatric surgical resident at the Yale University School of Medicine.

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