Application of Acellular Dermal Matrix in limb threatening wounds: Two cases presented

Aim

Diabetic Foot Ulcers (DFUs) are responsible for more hospitalizations than any other complication of diabetes, and approximately 15% result in lower extremity amputation.¹ We present two cases managed with Acellular Dermal Matrix (ADM): 1) A 55 year old female with a complex limb threatening DFU, 2) A 78 year old male with a surgical wound following a post-op infection from an Achilles tendon repair. In both cases an ADM was utilized to support wound healing to closure. The ADM we utilized is made of pure bovine collagen and glycosaminoglycan made from shark cartilage² and has two formats – a sheet style, with a thin outer layer made of silicone, which was applied on the ruptured Achilles tendon and a second format,  injectable, that was placed in the DFU patient’s difficult to access tunneled wound. ³

Method

Case 1: Following surgical debridement of a right heel DFU, and application of Negative Pressure Wound Therapy (NPWT) for five weeks prior, the wound measured at 3.5cm x 3.0cm with a tunnel area 3.0cm deep, probing to bone. The ADM was injected, a nonadherent sheet was laid over the area and NPWT was applied. Case 2: Wound debridement and then application of an 8cm x 4cm sheet of bilayer ADM was placed over the exposed Achilles tendon, covered with a nonadherent dressing, and NPWT of 75mm/hg suction continuous.

Results

In both cases complete wound closure occurred.  In the case of the DFU, this was significant as a below knee amputation was recommended by the health team upon her initial admission, but the individual refused. The medical history included poorly controlled diabetes, a recent admission for diabetic ketoacidosis, adrenal insufficiency, chronic anemia and chronic diarrhea.

Implications

ADM offers a suitable option when encountering complex limb or function threatening DFUs, and may also play an important role for exposed tendon