Cryopreserved Umbilical Cord for Treatment of a Wound with Exposed Tendon

Introduction: Wounds with exposed tendon present a difficult treatment challenge to the physician. In these wounds, the environment is often malnourished and is susceptible to desiccation and infection. This subsequently may lead to tendon necrosis, loss of range of motion (ROM), and decreased functionability. Umbilical cord (UC) tissues have been used to expedite wound healing for similar cases of complex foot ulcers. Herein, we present the use of UC to promote healing and function restoration in a postsurgical wound of the wrist with exposed tendon.

Methods: A 69-year-old male presented with a postsurgical wound on his left wrist. The patient had failed carpal tunnel release, median nerve neurolysis, brachioradialis tenotomy, and extensor tenolysis one month previously. The full-thickness wound was transudative and malodorous with exposed tendon surrounded by dead necrotic slough and 26–50% eschar. The patient complained of joint pain and was at risk of losing functional use. The wound was initially debrided, cleansed, and treated with advanced wound care dressings for the first week. Patient was prescribed antibiotics.

At three weeks, the wound edges had started to progress, but the patient continued having motor weakness; therefore, a UC allograft was applied to promote accelerated healing. At six weeks, the patient regained full ROM in their wrist and fingers with notable pain reduction and received a second UC to continue healing over the exposed tendon. At eight and nine weeks, granulation bud formation occurred on the proximal tendon, and a third and fourth UC application were applied, resulting in epithelialization around the wound edges. By 13 weeks, the granulated wound healed and the patient had full ROM with complete function.

Conclusion: In this case, use of UC promoted granulation tissue formation over exposed tendon followed by rapid epithelialization of a nonhealing, full-thickness, postsurgical wound without complication.