Biologically Active Skin Allografts Aid in Closure of Wounds with Exposed Bone and Tendon

Problem: Deep wounds with exposed bone and/or tendon are especially difficult to heal. Poor perfusion of these substructures inhibits the development of granulation tissue and subsequent reepithelization, and increases the risk of infection. Management of these complex wounds is dependent on achieving coverage, and frequently involves surgery using flaps or split-thickness skin grafts to achieve coverage. The dangers associated with this type of complex surgery is exacerbated by comorbidities and advanced age, which frequently accompany these difficult wounds. Biologically active cryopreserved human skin allografts have been shown to be a safe and effective alternative for treatment of these difficult wounds with exposed bone and tendon. We present four challenging cases treated in this fashion.

Case 1: A 76 year-old diabetic with recurrent wounds along his lateral leg following hardware removal, resulting in a nonhealing full-thickness wound with exposed fibula.

Case 2: An 84 year-old with significant skin atrophy and exposed tendons of the hand following repair of a ruptured extensor.

Case 3: A 62 year-old with exposed patellar tendon, following total knee arthroplasty and subsequent debridement. Patient previously failed placental and bovine skin substitutes.

Case 4: A 63 year-old with exposed Achilles tendon following a cat bite and pasteurella infection.

Methods: Cryopreserved biologically active split-thickness skin allografts were utilized to cover exposed tendon and bone in order to stimulate wound healing and preserve function. All grafts were performed in the clinical setting without the need for a surgical suite, anesthesia, and associated risks.

Results: Wound closure was achieved in all four cases, and function was maintained without the need for more complex surgical procedures and associated risks.

Conclusion: Cryopreserved split-thickness allografts are an excellent alternative for patients with significant comorbidities when surgery with flap coverage is not an option. In this series, all wounds closed, and all tendons and bone were preserved.