(CS-068) Complete closure of full thickness infected diabetic ulcers and infected Tibialis Anterior tendon with a fish skin xenograft in a Type I diabetic patient with Charcot Lisfranc fracture/dislocation
Introduction: Charcot Lisfranc fracture/dislocation cases that are complicated by the presence of full thickness infected ulcers and major tendon involvement can be challenging in creating a successful functional and fully healed outcome. These patients are often neuropathic due to diabetes and often have multiple additional comorbidities. The challenges include treating the infection, the timing and technique for a functional reduction and fixation, and healing and maintaining wound healing and function.
Methods: This 33 year old Type I Diabetic first presented to the ED with an infected Charcot Lisfranc fracture/dislocation with exposed, infected and partially devitalized Tibialis Anterior tendon. The patient had no pain due to sever diabetic neuropathy. She also had a history of cardiac and renal disease and hypertension. She was a poorly controlled diabetic with HgbA1c of 12. The patient was admitted to the hospital, xrays had confirmed the Lisfranc fracture/dislocation most closely resembling a Myerson Hardcastle Type A . Medical, cardiac, renal and diabetic management was initiated. ORIF was delayed due to the presence of full thickness infected ulcers medially laterally and on the anterior ankle. Debridement of the ulcers, deep wound cultures were obtained and the IV antibiosis was adjusted to reflect the results. Successful treatment of the infection was followed by ORIF. The patient was discharged from the hospital and significant ulcers were still present medially laterally and anteriorly. We followed the patient and treated her weekly on our wound center, but healing was stalled despite compliance and offloading. We decided to use Omega 3 fish skin xenograft and final closure occurred after 10 applications in total for the 3 ulcers.
Results: The 3 foot ulcers were closed after 10 applications of fish skin xenograft . The patient was able to return to work with custom orthoses and approved shoe gear and maintained healing with a plantigrade foot and function of the Tibialis Anterior tendon
Discussion: The fish skin xenografts have shown to closely resemble human epithelium and are also minimally processed and as a result , provide clinicians with an excellent product to assist in healing their wound patients. In this case were were able to cover difficult full thickness wounds and Tibialis Anterior tendon and return our patient to their previous life and work. The patient also has serious medical issues at well that she is also seeking care for and that we are part of monitoring for compliance and success in the future.
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