(CS-152) Meshed Human Reticular Acellular Dermal Matrix for Wound Closure Over Bone: A Case Series

Evan Adler, DPM; Tayyaba Hasan, DPM

Introduction: Wound closure after amputation is challenging during podiatric foot and ankle surgery due to the complex nature of the amputation, either stemming from infection or gangrene from peripheral arterial disease.  Surgical planning is paramount to remove all the necrotic tissue and try to provide a functional limb without extensive soft tissue and osseous loss.  Instances where the soft tissue loss is greater than the osseous loss during amputation, further osseous resection or grafting over bone need to be employed.  To date, there are not adequate studies defining the success of grafting directly over bone.  The purpose of this study is to present our experience of using a meshed human reticular acellular dermal matrix (HR-ADM) to assist with wound closure with bone exposed in the wound bed.

Methods: In this case series we present 10 patients who underwent amputation with exposed bone after the amputation.  Meshed HR-ADM was then applied overlying the bone and secured over the wound with either absorbable sutures or staples.  Negative pressure wound therapy (NPWT) was then utilized for roughly 4 weeks.  The patients were followed as an outpatient in the wound care center weekly until closure of the wound was obtained and received placental tissue applications in the wound care center as well.

Results: 10 patients who underwent initial amputation with human dermal allografting over bone were included in this study with NPWT application.  In our small case series, 100% of these patients had successful closure of the wound.

Discussion:

Closure of post-surgical wounds post-amputation with exposed bone presents a major problem in regards to limb salvage.  The longer wounds are left open, the higher  chances of infection, but in patients that  require amputation, the rate is significantly increased due to their underlying medical comorbidities.  The results from this case series, provide evidence that human dermal allograft applied over the bone with NPWT resulted in wound closure. This was beneficial to prevent more proximal amputations and support limb salvage.


Trademarked Items: SomaGen by MTF Biologics

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