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Case Study/Series
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DFU: Clinical and economic success with dermal replacement therapy in the outpatient wound care center First Author: William J Ennis Authors: Cynthia Sheehan RN, Douglas Smith BS, Patricio Meneses Ph.D. In published randomized controlled trials patients receiving standard of care achieve healing of 24.2% at 12 weeks and 30.4 % at 24 weeks.1 New technologies including bioengineered tissue and modalities result in healing rates of 50.6% and 40.7% at 12 weeks respectively.2,3 Infection complicating plantar DFU's often leads to either amputation or complex, costly plastic and reconstructive repairs. Recently at the Comprehensive Center for wound and disease management at St. James Hospital in Olympia Fields, IL an outpatient protocol has been developed for the use of Integraª (Integra Life Sciences) dermal replacement for the treatment of complex, plantar neuropathic ulcers. Integra? is a bilaminar membrane system consisting of a porous coprecipitate of bovine tendon type 1 collagen and shark glycosaminoglycan (chondrotin-6-sulfate) covered with an outer layer of silicone. After extensive excisional debridement of the plantar ulcer and removal of all non-viable tissue along with several millimeters of the wound periphery MIST? (Celleration Inc, Eden Prairie, MN) ultrasound is used to prepare the wound bed. Integra? is then stapled into place. The dermal template is further secured with the use of negative pressure wound therapy (VAC?- KCI San Antonio, TX) for 4 days as an outpatient. The dressing is removed at day 4 and for approximately 20 additional days, a daily dressing of Acticoat? (Smith and Nephew, Largo Fla) is applied along with compression. At the end of 28 days (sooner in select cases) the silicone is removed and the wound is treated with either wound modalities to enhance epithetlialization or Apligraf? (Organogenesis-Canton,MA) is implanted. This presentation will review the surgical procedure, clinical outcomes and an economic comparison between performing this procedure in the clinic as opposed to the traditional inpatient acute care setting. |
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