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Oral Abstracts (Session 1 of 5)
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(Presentation 32.4) A solution to the worse case scenario: successful treatment of class IIID diabetic foot ulcers using an acellular regenerative tissue matrix Brock A. Liden, DPM; Jodi F. Hartman, MS; Michelle L. Wright, BS The University of Texas Diabetic Wound Classification System is a standardized, practical method of evaluating diabetic foot wounds based on the depth of the wound and the presence of infection and ischemia. Wounds penetrating to bone or into a joint are the most severe and are classified as Grade III. Treatment is further confounded by the staging of the wound, which is determined by the presence of infection and/or ischemia. Ischemic wounds that are infected are classified as Stage D. Wounds that penetrate into bone often are osteomyelitic. Therefore, Class IIID wounds pose a significant challenge to wound care clinicians, as they are the most complex and frequently are resigned to below-knee amputation. Eleven consecutive Class IIID diabetic wounds were treated according to a standardized wound management protocol involving the application and multi-modal postoperative management of an acellular regenerative tissue matrix. The mean wound age was 22.1 weeks (2.7–111.0). All wounds were ischemic and osteomyelitic. In addition, 81.8% were neuropathic. Mean times to graft incorporation, 100% granulation, and wound healing were 0.88 weeks (0.43–1.9), 5.4 weeks (0.43–14.9), and 14.8 weeks (7.0–20.9), respectively. The graft success rate was 81.2%. One failure resulted from 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, 10 of 11 wounds in the study healed, yielding a healing rate of 90.9%. There were no below-knee amputations. Utilization of an acellular regenerative tissue matrix and a multi-modal postoperative management protocol successfully healed the most complex of wounds, preserving limbs that may otherwise have required below-knee amputations. In addition, despite compromised vascular status and infection, relatively remarkable rates of closure and healing were achieved. |
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