Aseptically Processed Dehydrated Placental Allograft for Pressure Ulcer Reconstruction: A Retrospective Review

Introduction: Pressure injury with secondary ulceration is a challenge for surgical healing following reconstruction. Previously, we have reported the use of placental allografts for incisional management following surgical closure of chronic wounds.  The challenges of pressure injury are twofold: the chronicity of the wound and the associated bioburden. Placental allografts provide matrix proteins and support wound progression. While incisional management following closure of chronic wounds may benefit from the addition of aseptically processed dehydrated allograft placental mini membrane to assist in optimizing the tissue for surgical healing, the value of optimization of the wound bed may also be beneficial for partial surgical healing with secondary healing as an alternative.Methods:We present a retrospective review of a series of surgical reconstructive procedures for pressure ulceration over a 2-year period using Aseptically Processed Dehydrated Placental Allograft for Pressure Ulcer Reconstruction. Over the 2- year period 46 patients presented with 62 pressure ulcers, with some patients presenting with multiple ulcers. Forty-four patients underwent surgical reconstruction with closure. One patient who presented on two occasions underwent debridement without closure because of poor nutritional status. All of the patients who underwent surgical closure except one underwent placement of placental allograft intraoperatively.Forty-one (93%) of the patients left the hospital with no complications to include infection and or dehiscence.  Three patients experienced incisional dehiscence with no evidence of infection and underwent operative closure and/or allowed to heal secondarily.Discussion: The addition of dehydrated placental allograft placental may improve surgical outcomes in patients undergoing pressure ulcer surgery. The aseptically processed placental tissue without terminal sterilization is known to maintain native matrix proteins, which support wound closure and healing.   We found that surgical outcomes were encouraging in the face of chronic inflammation and bioburden as is the case for pressure injury. While some patients experienced dehiscence, these patients were treated successfully with reoperation and or secondary healing. References:References 1. DiDomenico LA, Orgill DP, Galiano RD, et al. Use of an aseptically processed, dehydrated human amnion and chorion membrane improves the likelihood and rate of healing in chronic diabetic foot ulcers: A prospective, randomized, multi-centre clinical trial in 80 patients. Int Wound J 2018; 15: 950-957. 2. Zelen CM, Orgill DP, Serena TE, et al. An aseptically processed, acellular, reticular, allogenic human dermis improves healing in diabetic foot ulcers: A prospective, randomized, controlled, multicenter follow-up trial. Int Wound J 2018: 1-9.