(CS-089) Application of Human Allograft Adipose Matrix* for Prevention of Recurrent Diabetic Foot Ulcerations

Introduction: Diabetic foot ulcerations are challenging given their multifactorial complexity and high propensity for recurrence. Recurrent ulcerations increase the risk for infections that may lead to amputations, with resultant functionality impairments increasing patient mortality rates. Additionally, recurrent ulcerations can occur in areas with a deficient subcutaneous adipose layer over bony prominence. Treatment options generally involve the use of padding and offloading techniques, but these have been shown to fail with patient non-compliance. Allograft adipose matrix (AAM) is an “off-the-shelf” treatment option that can provide a natural cushion to support the deficit adipose tissue layer. This case series examines how AAM can cushion a deficit subcutaneous adipose layer, which may prevent incidence of recurrent ulcers.

Methods:

Case 1 is a 58-year-old male with a recurrent diabetic ulcer to the plantar medial aspect of the left hallux. Despite multiple off-loading attempts for the last 5 years, the ulcer has reoccurred. This time, the ulcer extended down to the bone with localized cellulitis. Biopsy confirmed no underlying osteomyelitis or malignancy. Case 2 is a 86-year-old male with a recurrent diabetic ulcer to the plantar aspect of the left first metatarsal for 1 year. The wound extended down to the subcutaneous tissue. Case 3 is a 73-year-old male presenting with a recurrent diabetic ulcer to the plantar aspect of the left fifth metatarsal for 1 year.

Surgical closure of the wound was achieved with a local rotational flap technique. Once the surgical site was resolved in all cases, 1.5cc of AAM was applied subcutaneously to the area of recurrent ulceration in the office setting and patients were followed up for recurrence of ulcerations.

Results: In all cases, no recurrence of diabetic ulcers were noted after single application of AAM in all patients spanning from 7 months to 2.5 years.

Discussion:

The use of AAM may be an effective modality to assist in preventing recurrent ulcerations by supporting a well-cushioned subcutaneous layer with this at-risk population.

Trademarked Items: Leneva

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