Hard to Heal Diabetic Foot Ulcers Treated Interchangeably With Dehydrated Human Umbilical Cord Expandable and Dehydrated Human Amnion Chorion Membrane Allografts Case Series

Introduction: Diabetic foot ulcers (DFUs) are an unfortunately common and grave complication of diabetes mellitus with up to 34% of people with diabetes potentially developing lower extremity ulcers over their lifetime.1,2 The goal of DFU management is to provide an environment that supports rapid and complete re-epithelialization to minimize the risk of further complications. Methods:Retrospectively reviewed the clinical treatment course of two consented patients with DFUs.Results: Case 1 is a 55-year-old diabetic male who presented with a chronic DFU on the right heel. He had multiple co-morbidities including a Chopart amputation of the right foot as well as a contralateral below knee amputation. Prior local wound care had failed to close the DFU resulting in the patient being referred to a wound care center (WCC) where more advanced treatment options were available. The wound area was successfully decreased with 2 months of weekly applications with dehydrated Human Amnion Chorion Membrane (dHACM) allografts and topical oxygen therapy, but failed to achieve complete re-epithelialization. Patient underwent further surgical debridement in the OR. Topical O2 was discontinued and a dehydrated Human Umbilical Cord Expandable (dHUC EX) allograft was applied to the wound measuring 27.5 cm2. After 1 week the DFU area reduced to 19 cm2. dHACM was then restarted and by week 12 after 8 applications of EpiFix the DFU resolved. Case 2 is a 53-year-old diabetic male who presented to the emergency department with a DFU involving the left hallux. The wound was debrided in the OR.  He was discharged from the hospital at 4 weeks after refusing a hallux amputation. One month later he was seen in the WCC where EpiFix was initiated and routinely applied until a planned second surgical debridement. During the second surgery, dHUC EX was applied.  Cultures and pathology reports returned positive for acute/chronic osteomyelitis in hallux. Appropriate antimicrobial therapy was initiated. Wound closed at week 12 with 8 applications of EpiFix following the application of EpiCord Expandable. Conclusion:These two cases demonstrate the potentially favorable impact of a novel dHUC EX allograft barrier on supporting the healing cascade when used interchangeably with dHACM.