Problem:  4 patients with 5 lower extremity ulcers were treated in Outpatient Wound Center. Patient A presented 3/06 with left pretibial ulcer secondary to venous insufficiency.  Patient B presented 8/06 with bilateral right lower extremity ulcers secondary to venous insufficiency complicated by MRSA. Patient C presented 9/06 with non-healing surgical wound secondary to amputation of second toe.. Patient D presented 2/07 with necrotic left ankle traumatic ulcer.

Past Management: Patient A was managed with sharp and enzymatic debridement, silver hydrofiber, foam, and tryspin-balsam peru dressings as well as light compression from 3/06-9/07 without resolution. Patient B was managed with cadexamer iodine, enzymatic debridement, hydrofiber dressings, hyperbaric oxygen therapy and compression therapy from 8/06-8/07 without resolution. Patient C was managed with enzymatic debridement, hydrofiber, collogen, alginate and cadexamer iodine dressings from 9/06-9/07 without resolution. Patient D was managed with enzymatic debridement and collogen dressings from 1/07-8/07 without resolution.

Current Approach: Patient A had Acellular Human Dermal Matrix Graft (AHDMG) placed 9/06. Patient B had AHMDG placed 8/07. Patient C and D had AHMDG placed 9/07.

Patient Outcomes: Patient A had wound resolution 11/06. Patient B had complications related to MRSA with decrease in wound volume of both ulcers as of 11/07 although wounds not resolved. Patient C has had decrease in wound volume by 11/07 although wound not completely resolved. Patient D had wound resolution 10/07.

Conclusion: The AHMDG is a viable option for promoting wound volume decrease and/or closure.

*Graftjacket Regenerative Tissue Matrix (Wright Medical)