Chronic Pressure Injuries: More than Taking the Pressure off with Lyophilized Human Amnion/Chorion Membrane

Introduction: Chronic pressure injuries are known to place patients at high risk for poor health outcomes, including death and disability.1 For example, expedited wound closure is imperative because secondary infections are a concern and deleteriously impact the patients' acute and long-term well-being and longevity.1  Advanced care is recommended when wounds, including PI, lack a 40- 50% reduction area after receiving four weeks of the standard of care. 2-4   Armstrong and Tettelbach reported significantly reduced healthcare utilization (i.e., hospital ER visits and readmission rates) and costs in similar chronic wounds when allografts were employed following parameters for use.3-5 Lastly, highlighting PI clinical outcomes with MIMEDX allograft use, Berhane et al.6 published a series of ten cases concluding that MIMEDX’s allografts are a viable treatment option for categories II and III PI. At the eight-week mark, they detailed expedited wound size reduction in 90% of the included PI, including three closed completely. This is noteworthy considering the complexity of the included patient population (most were obese to morbidly obese) and the chronicity of their PI, which frankly mirrors the patients whose providers have access to MIMEDX allografts for their treatments every day. Despite this and other widely published evidence, insurers frequently challenge or disallow allograft coverage for patients with chronic PI. This poster focuses on a polymorbid patient receiving polypharmacy with a stage 4 PI measuring 6.7x 5.3x 0.9 cm at the initiation of a novel treatment: lyophilized human amnion and chorion membrane (LHACM).Methods:A 69-year-old man presented to our outpatient wound clinic with a chronic unstageable PI. On a subsequent assessment, the PI was classified as a sage 4 measuring 6.7 x 5.3 x 0.9 cm. In addition to standard of care, including sharp debridement, LHACM was applied every other week until the wound closed.Results:After 10 applications of LHACM, the PI closed, and the patient was discharged.Discussion: Patients with chronic PI commonly fail standard therapies. In addition, these patients face delays and interruptions in care from insurers denying LHACM treatment coverage.    Through education and evidence-building, we can successfully treat and support this vulnerable patient population. Timely access to appropriate treatments, including LHACM, is key to helping these patients.References:1. Mondragon N, Zito PM. Pressure Injury. [Updated 2022 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557868/ 2. Wu S, Carter M, Cole W, et al. Best practice for wound repair and regeneration use of cellular, acellular and matrix-like products (CAMPs). J Wound Care. 2023;32(Sup4b):S1-S31. doi:10.12968/jowc.2023.32.Sup4b.S1 3. Armstrong DG, Tettelbach WH, Chang TJ, et al. Observed impact of skin substitutes in lower extremity diabetic ulcers: lessons from the Medicare Database (2015-2018). J Wound Care. 2021;30(Sup7):S5-S16. doi:10.12968/jowc.2021.30.Sup7.S5 4. Tettelbach WH, Armstrong DG, Chang TJ, et al. Cost-effectiveness of dehydrated human amnion/chorion membrane allografts in lower extremity diabetic ulcer treatment. J Wound Care. 2022;31(Sup2):S10-S31. doi:10.12968/jowc.2022.31.Sup2.S10 5. Tettelbach WH, Driver V, Oropallo A, et al. Dehydrated human amnion/chorion membrane to treat venous leg ulcers: a cost-effectiveness analysis. J Wound Care. 2024;33(Sup3):S24-S38. doi:10.12968/jowc.2024.33.Sup3.S24 6. Berhane CC, Brantley K, Williams S, Sutton E, Kappy C. An evaluation of dehydrated human amnion/chorion membrane allografts for pressure ulcer treatment: a case series. J Wound Care. 2019;28(Sup5):S4-S10. doi:10.12968/jowc.2019.28.Sup5.S4