Use of a Fully Synthetic Bioengineered Wound Matrix in Chronic Neuropathic Foot Ulcers

Objective

Long-standing chronic ulcerations of the lower extremity are uniquely challenging in regards to pathophysiology and biomechanics. This series outlines the use of a fully synthetic wound matrix that exhibits durability and allows for cell migration and angiogenesis while resisting enzymatic degradation. It is structurally similar to native extracellular matrix (ECM) without risk of reaction to human or animal tissue.

Materials/Methods

The wound matrix was applied to clinically non-infected ulcers following cleansing and sharp debridement. It was either affixed with nonadherent dressing and steristrips, or sutured with chromic gut. The graft was left in place with secondary dressings intact for the first 7 days.

Findings

Case #1:

71 y/o neuropathic diabetic male with medial left ankle ulcer for 50 years due to weightbearing on valgus deformity. Product was applied to wound area of 14.57cm and patient began nonweightbearing. Two applications were performed six weeks apart. A 71.3 percent area reduction (PAR) was achieved in 57 days.

Case #2:

73 y/o neuropathic male with right medial midfoot ulcer due to Charcot and previous hallux amputation open for over one year. Product and total contact cast (TCC) were applied on the same visit to wound area of 4.32cm. Three applications were performed two weeks apart. An 86.1 PAR was achieved in 54 days.

Case #3:

90 y/o neuropathic diabetic male with ulcer to the right Achilles present for four years. The product was applied to a wound area of 4.68cm. Three applications were performed two weeks apart. A -50.0 PAR was achieved in 29 days, suggesting complication of the graft over tendon.

Conclusions

The outcome of this study suggests a fully synthetic wound matrix can be used as an alternative to human or animal ECM in chronic, hard-to-heal neuropathic ulcers of the subcutaneous tissue.