Chronic Foot Ulcer, Secondary to Radiation Necrosis in the Treatment of Kaposi’s Sarcoma, Managed Uniquely with a Combination of Micronized Dehydrate Human Amnion Chorion Membrane and Decellularized Human Collagen Matrix

Introduction: Kaposi’s sarcoma is a highly vascular (“angioblastic”) tumor of the skin characterized by soft purplish plaques that form nodules. It typically starts on the feet and ankles and then slowly spread across the skin of the legs, hands, and arms. It is caused by human herpesvirus 8 (HHV8). Kaposis’s sarcoma was first described in 1872 by Moris Kaposi Kohn (1837–1902).

Summary: An elderly retired physician and pathologist of Greek descent noted erythematous lesions on his right foot in 1980. He attributed the lesions to irritation from his footwear and experienced no other symptoms. Over the span of 14 years, the lesions increased in size, leading the physician to have a biopsy performed. Kaposi’s sarcoma was diagnosed, and the patient eventually opted for treatment that included radiation therapy in 2001.

Method: While the Kaposi’s responded to the radiation therapy, necrosis of underlying soft tissue and bone resulted in several decades of frustration and failed treatments. Necrotic bone was subsequently excised in 2017, resulting in a chronic wound measuring 1.0 cm x 1.0 cm x 0.5 cm in the prior irradiated field. The ulcer base showed no evidence of vascularity and did not bleed during serial debridement. In 2018, dHCM was applied onto and mdHACM was injected concurrently into the patient’s wound during a period covering approximately 10 months. The ulcer was debrided regularly and offloaded with a soft Total Contact Cast and a post-op shoe. The ulcer resolved in December 2018 and the patient remains ambulatory and symptom-free.  

Conclusion: The late effects of radiation therapy related to wounds pose challenges to healing, as fibrosis, reduced vasculature, and skin atrophy disrupt the normal phases of healing. Concomitant use of dHCM topically and mdHACM injectable resulted in a successful outcome of a chronic radiation necrosis wound that had its genesis in 2001, approximately 17 years before resolving.