Case Series/Study

(CS-032) Treatment of Non-Healing, Unclassified Ulcerations of the Lower Extremity Using Chorion Free Amniotic Membrane Allograft: A Case Report

Co-Author(s):

Valarie Samoy, DPM; Jodi Walters, DPM

Introduction: Amniotic membrane (AM) is a rich source of biological factors which has proven a critical role in wound care. When applied to wounds, AM provide amino acids, growth factors, and various nutrients which have proven to facilitate cellular migration and promote wound repair.3 Studies reveal reliable evidence of healing time reduction over conventional wound care methods.2
<p class="default" style="font-variant-ligatures: normal; font-variant-caps: normal; orphans: 2; text-align: start; widows: 2; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial; word-spacing: 0px;">Our 54-year-old male patient with well controlled Diabetes Mellitus type 2, was diagnosed with COVID19 in July of 2020, Patient awoke in ICU after 13 days of intubation, physical exam revealed wounds on left foot and left hand. Wounds on the left foot were in the following locations and dimensions: Distal hallux: 2.5 x 3.0 x 0.1 cm, distal 5th digit: 1.0 x 1.0 x 0.1 cm, and dorsum of the foot: 2.0 x 2.0 x 0.2 cm. Wounds recorded as granular, with portions of eschar and/or fibrotic tissue, no wounds probed deeply, minimal serosanguinous drainage, no signs of infection. Neither medical records nor patient’s medical team could comment on origin or onset of wounds. Methods: <span style="font-size: 12.0pt; line-height: 107%; font-family: 'Times New Roman',serif; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">After cleansing wounds, non-viable tissue was debrided, AM was then applied and secured to lower extremity wounds with clean dressings. Patient was seen weekly in clinic for wound debridement and AM application. Wound dimensions were recorded and tracked. Results: <span style="font-size: 11.0pt; line-height: 107%; font-family: 'Calibri',sans-serif; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-bidi-theme-font: minor-bidi; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">The hallux wound had a total of 11 applications of AM with 100 days to full epithelialization, an average of 9.09% wound closure per week. The 5th digit wound had a total of 5 applications and 37 days to full epithelialization, an average of 16.67% wound closure per week. The dorsal foot wound had a total of 8 applications and 65 days to full epithelialization, an average of 12.75% wound closure per week. Discussion: We offer several differential etiologies, including an emerging phenomenon called “COVID toe”, which has similar presentation to Chilblains (pernio) dermatitis, these ulcerations are thought to be connected to peripheral constriction of capillaries in the hands and feet.1 Pressure ulcerations, peripheral vascular pathologies, diabetic ulcerations or other phenomena are also possible etiologies. We conclude however, that AM application treatments are acceptable and effective in healing complicated ulceration wounds to the lower extremity. 
 Trademarked Items: PalinGen Membrane References: 1. Hernandez C, Bruckner AL. Focus on “COVID Toes”. JAMA Dermatol. 2020;156(9):1003. doi:10.1001/jamadermatol.2020.2062

2. Lakmal, K., Basnayake, O. & Hettiarachchi, D. Systematic review on the rational use of amniotic membrane allografts in diabetic foot ulcer treatment. BMC Surg 21, 87 (2021).

3. Thompson P, et al. Comparing human amniotic allograft and standard wound care when using total contact casting in the treatment of patients with diabetic foot ulcers. Adv Skin Wound Care. 2019;32(6):272–7.