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Clinical Research
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A standardized wound management protocol involving the use of an acellular regenerative matrix for the treatment of complex lower extremity wounds Brock A. Liden, DPM, Jodi F. Hartman, MS, Michelle L. Wright, BS Bioengineered skin grafts are promising treatment alternatives for chronic, nonhealing, full-thickness wounds that often are unresponsive to traditional therapies. This retrospective study is the first to assess the efficacy of an acellular regenerative tissue matrix for management of complex lower extremity wounds A standardized wound management protocol for the application and multi-modal postoperative management of an acellular tissue matrix is presented. The results of a consecutive series of 19 wounds (11 patients) in which this regimen was followed are provided. The female-to-male ratio was 2:1. The mean patient age was 60.8 years. Co-morbidities included peripheral vascular disease (89.5%), infection (79.0%), diabetes (73.7%), osteomyelitis (73.0%), neuropathy (68.4%), and obesity (57.9%). The mean wound age was 18.5 weeks (2.7-111.0). Wound locations included the foot (68.4%), calf (21.0%), ankle (5.3%), and knee (5.3%). University of Texas Diabetic Wound Classifications were as follows: 2 (10.5%) ID; 1 (5.3%) IIA; 3 (15.8%) IIC; 1 (5.3%) IID; 1 (5.3%) IIIB; and 11 (57.9%) IIID.. .Mean times to graft incorporation, 100% granulation, and wound healing were 0.97 weeks (0.43Ð2.7), 5.2 weeks (0.43Ð16.7), and 12.1 weeks (2.9Ð29.7), respectively. The graft success rate was 89.5%. One failure was due to repeated incidences of patient noncompliance; the other was caused by infection. A graft was re-applied to one wound, which subsequently healed within 7 weeks. Therefore, only 1 of the 19 wounds in the study did not heal, yielding a healing rate of 94.7% The absence of graft-related complications, combined with efficient and high rates of closure, suggests that this acellular matrix is a safe and efficacious treatment option for complex lower extremity wounds. These results also illustrate the universal applicability of this product, with success not only in less severe diabetic wounds, but also in complex wounds, many of which were previously untreatable and often resigned to amputation. |
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