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Case Study/Series
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A Multicenter Study Involving the Use of a Human Acellular Dermal Regenerative Tissue Matrix for the Treatment of Diabetic Lower Extremity Wounds First Author: Christopher Winters Authors: Brock A. Liden, DPM, Stephen A. Brigido, DPM, Melitta Simmons, DPM, Jodi F. Hartman, MS, Michelle L. Wright, BS This multi-center study presents the use of a human acellular dermal regenerative tissue matrix as an alternative treatment for 97 chronic, full-thickness wounds of the lower extremity in 71 diabetic patients. Co-morbidities included neuropathy (87.6%), cardiac disease (85.6%), peripheral vascular disease (81.4%), infection (54.6%), obesity (52.0%), and osteomyelitis (37.1%). Wound locations included the foot (86.6%), ankle (8.2%), and lower extremity (5.2%). Mean wound age was 18.6 weeks (1.3 Ð 191.4). University of Texas Wound classifications included 15 (15.5%) 1A, 1 (1.0%) 1B, 2 (2.1%) 1D, 18 (18.6%) 2A, 8 (8.3%) 2B, 4 (4.1%) 2C, 3 (3.1%) 2D, 3 (3.1%) 3A, 7 (7.2%) 3B, 3 (3.1%) 3C, and 33 (34.0%) 3D. Mean time to graft incorporation, 100% granulation, and complete healing was 1.5 weeks (0.43 Ð 4.4), 5.0 weeks (0.43 Ð 16.7), and 13.7 weeks (1.7 Ð 57.8), respectively. Overall graft success rate was 89.7%. One failed wound subsequently healed approximately 7 weeks after graft reapplication. The healing rate was 90.7%, as 88 or the 97 wounds healed. No statistically significant differences were observed between UT classifications and times to graft incorporation, 100% granulation, and complete healing. Absence of graft-related complications and high rates of closure in a wide array of diabetic wounds suggest that this graft is a viable treatment for complex lower extremity wounds. Lack of any statistically significant differences between UT grades and wound outcome endpoints lends further support to the universal applicability of this graft, with successful results in both superficial diabetic wounds and in wounds penetrating to the bone or joint. |
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