Initial Observational Evaluation Using Naturally Neotenic1 Salamanders (Ambystoma Mexicanum) as Clinical Device for Wound Management of Toe Amputations Resulting from Osteomyelitis

Introduction: Current solutions for managing recalcitrant foot wounds using advanced skin substitutes present several disadvantages including risks of rejection, disease transmission, and cultural prohibitions from mammalian-sourced materials. In this study, we explore the use of a xenograft tissue derived from the dermis of a regenerative species, the neotenic1 salamander (Ambystoma mexicanum, or axolotl), for clinical wound management post toe amputation.Methods:Medical records of three diabetic patients with peripheral neuropathy who experienced severe infections leading to osteomyelitis, necessitating surgical interventions were retrospectively reviewed. Each patient received axolotl dermis patches post amputation. Data collected included patients’ demographics, daily alcohol and tobacco use, surgical intervention type, rates of postoperative infection, wound dehiscence, and closure.Results:All patients achieved complete wound closure. Comorbidities affecting wound closure include osteomyelitis treated with antibiotics = 3 (100%), IIDM = 2 (67% patients 1&3), IDDM=1 (33% patient 2), peripheral neuropathy =2 (67% patients 1&2); renal failure = 2 (67% patient 2 &3), alcoholic cirrhosis and testicular cancer =1 (33% patient 3). All non-smokers. 100% of wounds treated with axolotl remained closed during the 3-month follow-up period. Patient 1: Amputation of the right toe with metatarsal resection. Post-surgically treated with a wound vacuum for two months without closure. Wound size 4.0 cm x 3.8 cm x 4. Patient received 7 applications of axolotl dermis, demonstrating closure at W1=20%, W3=36%, W10=100% resulting in durable wound closure sustained for 3 months. Patient 2: Amputation of the right great toe. Post-surgical, wound size 0.5 cm x 1.2 cm x 0.5 cm. Patient received 7 applications of axolotl dermis demonstrating closure at W1=25%, W3=85%, W9=100%. Closure maintained during 3-month follow-up. Patient 3: Left fifth toe amputation and fifth metatarsophalangeal resection. Post-surgically treated with a wound vacuum for seven weeks without closure.  Patient received 6 applications of axolotl dermis demonstrating closure at W1=35%, W9=96%, W12=100% resulting in durable wound closure sustained for 3 months. Discussion: The use of pro-regenerative axolotl dermis patches for wound management in patients with osteomyelitis shows significant potential for improving wound closure and preventing poor outcomes. This innovative approach warrants further clinical investigation and data collection to fully understand its benefits and applications.References:1 – Neotenic – organism retaining juvenile traits into adulthood