17.4 Limb salvage through a combination achilles tendon and ulcer repair using an acellular human dermal matrix: a case study     

Brock Liden, DPM; Berger Wound Care Center      

Creative techniques combined with safe and effective products provide surgical flexibility and expanded clinical options. This case demonstrated how powerful the combination of current treatment modalities with traditional surgical practice can be in saving limbs that would historically have been amputated. A 64-year-old woman with diabetes who had previously failed conservative treatment for a large skin wound with exposed Achilles tendon presented a 7-cm deficit and complete loss of Achilles tendon structure interoperatively. In attempt to salvage the limb, the gastrocnemius was sectioned and flipped to provide a bridge for the Achilles tendon. The mop ends of the Achilles tendon were resected and covered with an acellular human dermal matrix, GRAFTJACKET¨ Matrix 5 cm x 10 cm (Wright Medical Technology Inc, Arlington, Tenn). The graft was wrapped "burrito" style around the construct and anchored to the gastrocnemius proximally and the calcaneus periosteum distally. The remaining open ulcer area was closed with another acellular human dermal matrix. Throughout the tendon healing process, the patient was kept nonweight bearing. Additional treatment modalities were employed post-operatively to promote wound granulation and soft tissue coverage of the tendon. The Achilles tendon and diabetic foot ulcer had completely healed by 29.7 weeks allowing the patients full return to normal activities.