(CS-079) Application of Human Reticular Acellular Dermal Matrix* and Dehydrated Human Amnion/Chorion Allograft** for Limb Salvage for Complex Heel Wounds with Osteomyelitis

Co-Author(s):

Introduction: Lower limb amputations secondary to chronic, non-healing ulcerations are understood to be associated with higher rates of morbidity and mortality. Specifically, plantar heel ulcerations with clinical osteomyelitis are often treated with partial calcanectomy or lower limb amputation, both of which have severe functional limitations that can result in further deterioration and morbidity/mortality of the affected patient. These cases examine the role of human reticular acellular dermal matrix (HR-ADM) and dehydrated human amnion/chorion allograft (dHACA) for limb salvage of complex heel wounds with osteomyelitis that would have otherwise been treated with lower limb amputations.

Methods:

Case 1 is a 42-year-old male who presented with an infected open wound of his right heel. Case 2 is a 43-year-old female who presented with an infected open wound of her left heel. In both cases, acute osteomyelitis of the calcaneus was confirmed. Initial treatment modalities included incision and drainage with extensive debridement to excise all necrotic, nonviable tissue and placement of antibiotic infused cement beads. When the infection cleared, a foot intrinsic muscle flap with application of HR-ADM was performed. There was follow-up at the wound care center for continued management with biweekly dHACA application until closure.

Results: Full wound closure was achieved in both cases after application of HR-ADM and dHACA with no known recurrence (greater than 1.5 years in Case 1, 10 months in Case 2).

Discussion: Plantar heel ulcerations with associated calcaneal osteomyelitis can be difficult cases to manage. Treatment options such as partial calcanectomies or lower limb amputations have both been documented to have severe functional limitations for affected patients. HR-ADM and dHACA are both effective modalities to assist wound closure in these complex cases.

Trademarked Items: Salera (MTF Biologics, Edison, NJ)
AlloPatch (MTF Biologics, Edison, NJ)

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