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Treatment and closure of chronic wounds with tendon, bone or hardware exposure has historically been very challenging. Treatment in the past in our Wound Center has been topical dressings and antibiotic therapy, as the skin substitutes we used were not indicated for these wound types. Outcomes of other topical therapies has not produced optimal results. These treatments can take many weeks to months, may require subsequent hospitalization, and ultimately did not achieve healing.
In our search to find an alternative for these specific wound types, we trialed a cryopreserved placental membrane. Five patients meeting our criteria of tendon, bone or hardware exposure in the wound and insurance approval were selected for this study. All five selected patients had lower extremity wounds and had failed previous treatment modalities. Numerous treatments were utilized with failure to achieve healing included advanced dressings, negative pressure therapy, hyperbaric oxygen and antibiotic therapy. Patient response to these treatments varied between cases however, these wounds were stalled with no progression of healing.
Although the cryopreserved placental membrane we chose for this study is indicated for use on various wounds, it is approved for wounds with tendon, bone or hardware exposure. Our Facility put limitations for the use of this product only with these specific wound types. These wounds are our most challenging wounds to heal. Limitations of this product included wait time for insurance prior authorization and therapeutic level of IV antibiotics.
Healing rates of all five cases using the cryopreserved placental membrane ranged from 3-15 weeks and 4-10 applications of the product. Patients reported less pain, they also expressed positive feedback regarding less cost and time for dressing changes . Our experience through this clinical trial demonstrated great outcomes and patient satisfaction.