Introduction: Complex wounds are difficult to heal since they can be deep and further challenged with comorbidities (diabetes, vascular disease, obesity). In the United States, over 6.5 million individuals have unhealed complex wounds. This study examines a combination treatment of human allograft tissue (dermal, amniotic, adipose) to support various stages of treatment and aid natural closure.
Case Study: A 53-year-old diabetic male (with hypertension, hyperlipidemia, hypothyroidism) developed gas gangrene on his left plantar foot (open over a year). The necrotizing infection initiated at the fourth metatarsal head and tracked to the third toe, the metatarsal phalangeal joint, and the flexor tendons to the plantar medial arch.
Method: Decompression of the infection involved debridement and removal of the soft tissue including the plantar fascia. The wound was packed twice daily with 0.25% Dakin’s for three days, followed by debridement of the nonviable skin edges and amputation of the third toe in the OR. Pre-meshed, human reticular acellular dermal matrix (HR-ADM) was applied in a single layer and contoured to the wound bed (day 4). The graft was secured with nylon sutures and dressed with oil emulsion dressing along with negative pressure wound therapy (NPWT). The patient was off-loaded with a knee walker and the NPWT was changed weekly. This strategy facilitated granulation-angiogenesis to rebuild tissue. To support epithelialization, aseptically processed dehydrated human amnion and chorion allograft (dHACA) was applied (week 11), casted, and changed biweekly. The subcutaneous tissue of a small open region (below the fourth metatarsal) received adipose allograft matrix (AAM) to supplement the atrophic fat pad.
Results: The patient was non-weight-bearing with a knee walker for three weeks and reached natural wound closure at week 15.
Conclusion: This unique case demonstrates that complex wounds may require a combination of allograft treatment to support natural wound closure depending on the depth and type of wound.