17.2 Rehydration of a human acellular dermal regenerative tissue matrix in a heparin-blood saline solution for the treatment of chronic diabetic lower extremity wounds          

Brock A. Liden, DPM; Melitta Simmons, DPM; Jodi F. Hartman, MS; Michelle L. Wright, BS; Circleville Foot & Ankle, Berger Health System

Rehydration of a human acellular dermal regenerative tissue matrix for wound management traditionally is in a saline solution. This study presents an alternative method of rehydration in a heparin-blood saline solution. Twenty-eight chronic, full-thickness wounds of the lower extremity were evaluated in 19 diabetic patients for whom a standardized application and postoperative management protocol involving the use of this matrix was used. Rehydration was achieved in a solution of 10cc of the patient's blood collected at the time of patient preparation, 1000 units of heparin, and enough sterile saline to cover the matrix. University of Texas Wound classifications included: 1 (3.6%) 1B, 1 (3.6%) 1C, 2 (7.1%), 1D, 3 (10.7%) 2C, 1 (3.6%) 2D, 1 (3.6%) 3B, 2 (7.1%) 3C, and 16 (57.1%) 3D. Mean time to graft incorporation, 100% granulation, and complete healing was 1.1 weeks (0.43Ð3.6), 5.3 weeks (0.43Ð16.7), and 15.9 weeks (1.7Ð38.0), respectively. Overall graft success rate was 89.3%. One failed wound subsequently healed approximately 7 weeks after graft reapplication. The healing rate was 92.9%, as 26 of the 28 wounds healed. Absence of graft-related complications and high rates of closure in a wide array of diabetic wounds support the use of this graft for the treatment of complex lower extremity wounds. The use of a heparin-blood saline solution for rehydration may enhance graft incorporation by stopping coagulation at the graft edges, permitting immediate blood flow across the graft, and enabling the host cells to begin utilization of the matrix as quickly as possible.