(CS-096) Human keratin graft speeds the healing of refractory venous legs ulcers

Venous leg ulcers (VLUs) account for 70-80% of all known leg ulcers worldwide. Present in 2% of the population, VLUs are associated with significant morbidity and negative socioeconomic impact [1,2].

A multi-modal approach to care must be taken to treat these often-refractory wounds. The use of keratin in wound healing promotes cell growth, migration, and differentiation. Keratin based products are known to assist with epithelialization, a more ordered healing process, and faster healing [3,4]. The first human keratin matrix graft* was used to treat a series of VLUs.


Methods:

We present a case series of nine patients with a total of 13 VLUs. Four patients had bilateral leg ulcers, and the rest single limb ulceration. Patients ages ranged from 45-85 years. The average age of the wound prior to treatment was four weeks. Standard local wound care, compression therapy, infection control, and exudate management were completed. All patients had venous and arterial evaluations.

The human keratin graft was applied after four weeks of conservative failure. The graft was fenestrated with an 11-blade and applied to the wound. Wound dressings were changed, and a new graft placed weekly.


Results:

Overall, 100% of the wounds were responsive to the human keratin graft. There was increased epithelialization and granulation tissue in the wound base. Six wounds healed with no recurrence. The average time to heal was 6-8 weeks. The mean number of applications of the graft was six. Six wounds opened but averaged a 50% decrease in size since treatment initiation. These wounds represent: the largest wounds, oldest age, bilateral, and remain complicated by recurrent infection and extensive exudate/lymphedema and poor patient compliance. These wounds remain in active treatment. Throughout the trial, one patient passed away from cardiac reasons.


Discussion:

This case series illustrates the benefits to using a human keratin graft to accelerate the healing of refractory VLUs. Additionally, there appears to be recurrence protection with the use of human keratin.


Trademarked Items: *ProgenaMatrix, ProgenaCare, US.

References: 1. Ren, S-Y., et al. Strategies and challegnes in the treatment of chronic venous leg ulcers. World J Clin Cases, 2020 8(21): 5070-5085.
2. Raffetto, J.D., et al. Why venous leg ulcers have difficulty healing: Overview on pathophysiology, clinical consequences and treatment. J Clin. Med, 2021 10, 29: 1-34.
3. Batzer, A.T., et al., The use of keratin-based wound products on refractory wounds. Int Wound J 2016. 13: 110-115.
4. Konop, M., et al. Keratin biomaterials in skin wound healing, an old player in themodern medicine: a mini review. Pharmaceutics 2021. 13, 2029: 1-20