(CS-058) Diabetic foot ulcer (DFU) with increased pressure on forefoot

Several thousands of diabetic foot ulcers occur annually in the U.S, of those many are  involving the lower extremity. Often, a significant soft tissue deficit is present leaving limited reconstructive options available to the surgeon or wound care provider. STSG is still considered the mainstay for treatment of large skin defects caused by traumatic wounds. Problems with graft loss, scar contracture, loss of elasticity, adhesions to tendons and unfavorable aesthetic results are regarded as limitations. In order to overcome these limitations, the use of acellular dermal matrix has shown success in the past.

We used an acellular fish skin dermal matrix for its native dermal structure, porosity, and biomechanical properties. It also provides a natural bacterial barrier rich in Omega3 fatty acids. Split thickness skin grafting was then performed to achieve final closure.

Methods:

We illustrate a case report where a fish skin acellar dermal matrix was utilized to facilitate granulation prior to STSG following a surgical reconstruction of foot.

Results:

Significant granulation tissue and coverage of depth was noted within the first week of application without the need for wound VAC usage. Skin graft substitute application allowed for early application of STSG and complete closure of the diabetic foot wound.

Discussion:

Diabetic foot ulcers cause a great deal of anguish and potential loss of limb or life.   Exposed underlying tendinous and osseous structures add to the complexity of the injury. Appropriate surgical debridement of non-viable tissue along with local wound care is often necessary.

With our patient, surgical debridement with amputation of the remnant 2^nd toe was performed with adjunctive skin substitute application. This allowed for rapid granulation and STSG. The patient underwent a full recovery with no limitations.

The utilization of a fish skin acellular dermal matrix appears to be a viable option to optimize diabetic foot wounds for STSG. It is our hope this can provide future clinical and surgical guidance to practitioners with similar traumatic wounds.

Trademarked Items: *KerecisTM, Kerecis, Isafjordur, Iceland

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