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Human acellular dermal wound matrix for complex diabetic wounds

    Abstract

    Objective:

    Diabetic ulcers are the most common foot injuries leading to lower-extremity amputation and the most common cause of non-traumatic lower extremity amputations in the industrialised world. Approximately 85% of all diabetes-related lower-extremity amputations are preceded by foot ulcers. When foot ulcers develop despite preventive measures, early and appropriate treatment should be initiated to help reduce the burden of diabetes-related amputations. Recent advances now offer these patients a regenerative process of restoring the wound with human integument by replacing damaged or missing tissue with similar tissue rather than scar formation. The aim of this product evaluation was to test the efficacy of regenerative products on complex diabetic wounds.

    Method:

    Before wound intervention, the underlying comorbidities of type II diabetes mellitus and osteomyelitis were treated. In the operating room, the wounds received a sterile surgical scrub and were treated with either regenerative tissue matrix sutured over the open wounds or regenerative flowable soft tissue scaffold placed in a plantar tunnelled wound. Negative pressure wound therapy (NPWT) was applied for 10–14 days to create an environment that promotes wound healing, to secure the grafts, and to facilitate adhesion of the matrix to the wound bed.

    Results:

    All wounds, three in two patients, completely epithelialised without any complications at the end of the 17-week follow-up period.

    Conclusion:

    With the absence of complications and successful wound epithelialisation in a variety of diabetic wounds, regenerative tissue matrix products have taken the next step forward in wound healing.

    References

    • 1 Hicks, C.W, Selvarajah, S., Mathioudakis, N. et al. Trends and determinants of costs associated with the inpatient care of diabetic foot ulcers. J Vasc Surg 2014 60: 5, 1247–1254. Crossref, MedlineGoogle Scholar
    • 2 Zhang, J., Hu, Z.C, Chen, D. et al. Effectiveness and safety of negative-pressure wound therapy for diabetic foot ulcers: a meta-analysis. Plast Reconstr Surg 2014; 134: 1, 141–151. Crossref, MedlineGoogle Scholar
    • 3 Hunt, N.A, Liu, G.T, Lavery, L.A The economics of limb salvage in diabetes. Plast Reconstr Surg 2011; 127: Suppl 1, 289S–295S. Crossref, MedlineGoogle Scholar
    • 4 Brem, H., Sheehan, P., Boulton, A.J Protocol for treatment of diabetic foot ulcers. Am J Surg 2004; 187: 5A, 1S-10S. Crossref, MedlineGoogle Scholar
    • 5 Brigido, S.A, Boc, S.F, Lopez, R.C Effective management of major lower extremity wounds using an acellular regenerative tissue matrix: a pilot study. Orthopedics 2004; 27: 1 Suppl, s145–s149. MedlineGoogle Scholar
    • 6 Boulton, A.J, Kirsner, R.S, Vileikyte, L. Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med 2004; 351: 1, 48–55. Crossref, MedlineGoogle Scholar
    • 7 Zhong, S.P, Zhang, Y.Z, Lim, C.T Tissue scaffolds for skin wound healing and dermal reconstruction. Wiley Interdiscip Rev Nanomed Nanobiotechnol 2010; 2: 5, 510–525. Crossref, MedlineGoogle Scholar
    • 8 Gupta, S., Ichioka, S. Optimal use of negative pressure wound therapy in treating pressure ulcers. Int Wound J 2012; 9: Suppl 1, 8–16. Crossref, MedlineGoogle Scholar
    • 9 Snyder, R.J, Hanft, J.R Diabetic foot ulcers - effects on quality of life, costs, and mortality and the role of standard wound care and advanced-care therapies in healing: a review. Ostomy Wound Manage 2009; 55: 11, 28–38. MedlineGoogle Scholar
    • 10 Harper, J.R, McQuillan, D.J A novel regenerative tissue matrix (RTM) technology for connective tissue reconstruction. Wounds 2007; 19: 6, 163–168. MedlineGoogle Scholar
    • 11 Berlet, G.C, Hyer, C.F, Lee, T.H et al. A soft-tissue interpositional arthroplasty technique of the first metatarsophalangeal joint for the treatment of advanced hallux rigidus using a human acellular dermal regenerative tissue matrix. Techniques in Foot and Ankle Surgery. 2006; 5: 4, 257–265. CrossrefGoogle Scholar
    • 12 Braun, L.R, Fisk, W.A, Lev-Tov, H. et al. Diabetic foot ulcer: an evidence-based treatment update. Am Jl Clin Dermatol 2014; 15: 3, 267–281. Crossref, MedlineGoogle Scholar
    • 13 Pelletier, E.M, Smith, P.J, Boye, K.S et al. Direct Medical Costs for Type 2 Diabetes Mellitus Complications in the US Commercial Payer Setting: A Resource for Economic Research. Appl Health Econ Health Policy 2008; 6: 2–3, 103–112. Google Scholar
    • 14 Kirsner, R.S, Bohn, G., Driver, V.R et al. Human acellular dermal wound matrix: evidence and experience. Int Wound J 2015; 12: 6, 646–654. Crossref, MedlineGoogle Scholar
    • 15 Stacey, D.H Use of an acellular regenerative tissue matrix over chronic wounds. Eplasty 2013; 13: e61. Google Scholar
    • 16 Williams, M.L, Holewinski, J. Experience using a flowable soft tissue scaffold in conjunction with a human dermal matrix in lower extremity wounds. Journal of Diabetic Foot Complications. 2013; 5: 3, 55–61. Google Scholar
    • 17 Reyzelman, A., Crews, R.T, Moore, J.C et al. Clinical effectiveness of an acellular dermal regenerative tissue matrix compared to standard wound management in healing diabetic foot ulcers: a prospective, randomised, multicentre study. Int Wound J 2009; 6: 3, 196–208. Crossref, MedlineGoogle Scholar

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