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Case Study
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Use of a novel bovine dermal-derived extracellular matrix* combined with NPWT** and HBO to heal a terminal, ischemic foot wound Michael S. Miller, DO, Marie Sterling, DO, Robert Stirling, DO, Terry Iwasko, DO, Karen Israel, DO, Cheryl McDaniel, LPN Extracellular matrix consists of attachment proteins, signaling molecules, structural proteins, and a collagen scaffold that provides the tissue with an organized structure. As tissue is formed, cells synthesize and secrete products required for the tissue's growth, architecture, and specialization. Collagen molecules assemble into a polymerized fiber scaffold, capture and immobilize other cell products and together, makes up the extracellular matrix. Primatrixª (TEI Biosciences, Inc.) is a strong, highly biocompatible, acellular collagen matrix derived from fetal bovine dermis. It is cell friendly, quickly vascularized, and provides an environment to facilitate new tissue growth Negative Pressure Wound Therapy has been shown to promote wound healing through multiple pathways, however, use of pressures higher than 100 mmHg has been demonstrated to increase the risk of tissue ischemia and inhibit healing in recent literature Hyperbaric Oxygen Therapy has great potential use in improving tissue oxygenation and potentially to facilitate healing of severely ischemic wounds A case is presented of a 76-year-old actively practicing physician who developed acute lower extremity ischemia resulting in a gangrenous open wound of the left foot, plantar aspect. At a large metropolitan medical wound care center, use of the KCI VAC at 175 mm Hg in combination with Dakin's solution soaks and topical antibiotics resulted in a scheduled BK amputation. He was emergently referred to the Wound Healing Center of Terre Haute. Angiography and subsequent emergency, deep, distal angioplasties were performed with excellent results. Primatrix was applied to the wound weekly with the BSM Versatile1 and Chariker-Jeter technique used at 40Ð60 mmHg 6Ð8 hours per day. Hydrogel was applied during ÒoffÓ periods. Three time weekly hyperbaric oxygen therapy was commenced. Using this combination of aggressive, complementary therapies, complete healing occurred allowing the patient to resume essentially normal activities **PrimatrixTM, TEI Biosciences, Inc.**BlueSky Medical Versatile 1TM La Costa, CA. Longaker MT, Whitby DJ, Adzick NC, et al. Studies in fetal wound healing, VI. Second and early trimester fetal wounds demonstrate rapid collagen deposition without scar formation. J Pediatr Surg. 1990;25:63Ð68 Knudsen BS, Harpel PC, Nachman RL. Plasminogen activator inhibitor is associated with the extracellular matrix of cultured bovine smooth muscle cells. J Clin Invest. 1987;80(4):1082Ð1089. Gray M, Pierce B. Is negative pressure wound therapy effective for the management of chronic wounds? JWOCN. 2004;5/6:101Ð105 Morykwas, MJ; Argenta, LC; Shelton-Brown, EI; et al: Vacuum Assisted Closure: A new method for wound control and treatment: Animal studies and basic foundation. Ann Plast Surg. 1997;38:553Ð562 Argenta LC, Morykwas MJ. Vacuum assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563Ð577 Miller MS: Lowery, CA; Negative pressure wound therapy: Ôa rose by any other name.Õ Ostomy Wound Manage. 2004;51(3):44Ð49 Miller MS. Commentary: new microvascular blood flow research challenges practice protocols in negative pressure wound therapy. WOUNDS. 2005;17(10):290Ð294.. .Wackenfors, Sjogren, Gustafsson. Effects of vacuum assisted closure therapy on inguinal wounds edge microvascular blood flow. Wound Repair Regen. 2004;12(6):600Ð606 Gimbell M, Hunt T. Wound healing and hyperbaric oxygen. In: Kindwall EP, Whelan HT, eds. Hyperbaric Medicine Practice. 2nd ed. Best Publishing Co:1999:169Ð204 Faglia E, Favales F, Aldeghi A, et al. Adjunctive systemic hyperbaric oxygen therapy in treatment of severe prevalently ischemic diabetic foot ulcer. A randomized study. Diabetes Care. 1996;19(12):1338Ð1343. |
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