Lyopreserved Placental Membrane with Viable Cells in Treatment of Wagner 4 Chronic Refractory Post-Amputation Surgical Site Dehiscence in Patient with Multiple Comorbidities

Lower limb amputation surgical site dehiscence occurs when the healed tissue fails to develop sufficient strength to withstand forces such as shear or direct trauma. Research suggests that transmetatarsal amputation (TMA) in diabetic, vasculopathic, and end-stage renal disease (ESRD) populations are associated with high complication rates, such as chronic stump ulceration and wound dehiscence, and are predictive of nonhealing. Here, we present a case of refractory wound dehiscence post-amputation.

A 63-year-old male with a history of diabetes mellitus, ESRD, neuropathy, hypertension, arterial disease, and previous amputation presented with a Wagner 4 ulcer at the TMA site. Earlier surgical intervention for gas gangrene and osteomyelitis resulted in the TMA. The wound failed to close for nine months standard of care (SOC) with 45 hyperbaric oxygen sessions and negative pressure wound therapy (NWPT).

Based on previously described positive outcomes of management of chronic wounds, vLPM was selected as the choice of an advanced wound product adjunct to SOC (2–3). SOC included sharp debridement, nonadherent dressings, and an appropriate offloading device. At the first vLPM application, wound size was 1.29 cm² with a depth of 2.1 cm.

The wound size reduced ~34% with no depth one week post-application and stayed the same the following week. vLPM application was interrupted for three weeks due to an unrelated to the wound hospitalization, resulting in wound size increase to 6.3 cm² with a depth of 2.3 cm. A second vLPM graft was applied. At two-week follow-up, wound size had reduced 47% with a depth of 1.4 cm. As of today, a third vLPM graft was applied with the expectation of complete wound closure by the next follow-up visit. There were no treatment-related adverse events.