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Application of a Bioengineered Electrospun Synthetic Polymer Matrix in Limb Salvage: A Case Series.
Introduction:Over 150,000 lower extremity amputations are performed in the United States each year, with 85% of lower-limb amputations in patients with diabetes, being preceded with an unhealed foot ulcer. This incidence is directly proportional to rates of peripheral arterial occlusive disease, neuropathy, and soft tissue sepsis. Compounding challenges with diabetes mellitus, which is present in 82% of all vascular-related lower extremity amputations in the United States, have an astounding 30 times greater lifetime risk of amputation when compared to patients without diabetes mellitus. In addition, of persons with diabetes who have a lower extremity amputation, up to 55% will require amputation of the second leg within 2‐3 years. While we have seen a decline in the number of amputations performed annually in, we must continue to strive to dramatically decrease amputation statistics.
Purpose:This case study, focused on the potential of a new bioengineered electrospun synthetic polymer matrix (3DESPM) to improve the healing trajectory of 7 complex non-healing wounds.Case #1 – 69-year-old female with 6 right lower extremity non-healing wounds. History of anemia, hypertension, DMII, L BKA (12 years prior), CVA, heavy smoker, wheelchair dependent, right lower extremity arterial occlusive disease with prior stents.Case #2 – 44-year-old female with a chronic left heel non-healing wound. History of neuropathy, hypertension, recurrent heel wound x 1 year, smoker, left heel abscess and osteomyelitis.
Methods:Electrospun synthetic polymer matrix was applied to seven wounds (2 patients) that were considered for amputation. As a limb salvage measure, each patient received multiple 3DESPM applications.
Results:All 7 wounds achieved closure avoiding amputation.Discussion:In this case series, limb salvage was achieved in 7 complex wounds. The morphology of 3DESPM mimics native hemodynamic ECM to encourage cellular adhesion, infiltration, and proliferation. Comprised of two naturally resorbable synthetic polymers, Polyglycolide or polyglycolic acid (PGA) and poly(L-lactide-co-caprolactone) (PLCL), 3DESPM naturally degrades via hydrolysis, into α-hydroxy acids and fatty acids to support tissue homeostasis and restore the body’s natural wound healing process.
References
ReferencesCenters for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2017American Diabetes Association. Economic costs of diabetes in the U.S. in 2017. Diabetes Care 2018;41:917–928Dillingham TR, Pezzin LE, Shore AD. Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations. Arch Phys Med Rehabil. 2005 Mar;86(3):480-6. [PubMed]Beckman JA, Creager MA, Libby P. Diabetes and atherosclerosis: epidemiology, pathophysiology, and management. JAMA. 2002 May 15;287(19):2570-81. [PubMed]Moxey PW, Gogalniceanu P, Hinchliffe RJ, Loftus IM, Jones KJ, Thompson MM, Holt PJ. Lower extremity amputations--a review of global variability in incidence. Diabet Med. 2011 Oct;28(10):1144-53. [PubMed]Lim, H.W., S.A.B Collins, J.S. Resneck, Jr, et al. 2017. The burden of skin disease in the United States. J. Am. Acad. Dermatol. 76: 958-972.e2.Driver, V.R., R.J. Snyder, T. Conner-Kerr & T. Thomas. 2014. AAWC Fact Sheet 1: CHRONIC WOUNDS The most important health problem you’ve never heard about. AAWC. Accessed January 24, 2018. https://s3.amazonaws.com/aawc-new/memberclicks/Fact-sheet-1-final_May-2014.pdfGrice, E.A. and J.A. Segre, The skin microbiome. Nat Rev Microbiol, 2011. 9(4): p. 244-53.; 4. Capone, K.A., et al., Diversity of the human skin microbiome early in life. J Invest Dermatol, 2011. 131(10): p. 2026-32.Weyrich, L.S., et al., The skin microbiome: Associations between altered microbial communities and disease. Australas J Dermatol, 2015. 56(4): p. 268-74.Schneider, L.A., et al., Influence of pH on wound-healing: a new perspective for wound-therapy? Arch Dermatol Res, 2007. 298(9): p. 413-20.
