A New Treatment Modality to Expedite Healing in the Case of a Transmetatarsal Breakdown

The patient is a 65 year old Polynesian male with a medical history of hypertension, dialysis dependent renal failure, coronary artery bypass, status post left below knee amputation and a recent right failing transmetatarsal amputation. The patient underwent a closed right transmetatarsal amputation for gangrenous toes in May 2020 by a podiatrist. This slowly began to fail and by November had extensive dry and wet gangrene present. The podiatrist referred the patient to a vascular surgeon who told him he would need a right below knee amputation (BKA). The family sought a second opinion.

He was seen by a second vascular surgeon December 29, 2020 and was found to have extensive wet and dry gangrene present; however, by Doppler he had biphasic signals in both the dorsalis pedis and posterior tibial arteries. He was advised that there might be a chance to salvage the transmetatarsal amputation. A regime of weekly debridements and daily wet to dry dressing changes produced steady improvement. One month later the wound appeared salvageable with only some peripheral dry gangrene and a 40% base of granulation tissue. In February the surgeon initiated treatment with AC5®Advanced Wound System (AC5) with the hope that it might shorten the healing time and expedite the growth of a base of granulation tissue. After 3 weekly treatments with AC5 as well as weekly debridements and daily dressing changes, there was a remarkable improvement in the wound.

The wound shrank from 4 x 3 inches to 3 x 1.5 inches with a near 90% coverage of healthy pink granulation tissue. The serosanguinous drainage initially present also nearly abated and peripheral dry gangrene considerably diminished. Wound healing of transmetatarsal breakdown was significantly expedited with a new wound management system, AC5. AC5 has been shown in prior clinical experience to promote healing of chronic, recalcitrant wounds, to provide a barrier of protection from biocontamination, to help reduce inflammation, and to provide a network for adhesion, migration, and proliferation of cytotypes fundamental to the cascade of wound healing.