Management of Complex, Recalcitrant, Lower Extremity Wounds using Advanced Wound Care Modalities

Background: Diabetic foot complications are often resistant to healing as a result of arterial insufficiency, which can lead to inadequate perfusion of the foot and eventually gangrene and amputation. Various treatment options exist to promote wound healing; however, evaluation of the wound environment and factors that impair wound healing need to be considered before selecting appropriate therapy.

Objective: Here, we present a 3-patient case series demonstrating successful wound closure using advanced wound treatments: negative pressure wound therapy (NPWT), oxidized regenerated cellulose/collagen/silver-ORC (ORC/C/silver-ORC) dressing, and hyperbaric oxygen therapy (HBOT).

Methods: All patients received systemic antibiotics and remained free of infection prior to initiating wound care management. Patient 1 was a 52-year-old diabetic male, with abscess and osteomyelitis of the left great toe that was present for several weeks. Patient 2 was a 67-year-old diabetic male who presented with abscess and osteomyelitis of the left midfoot of unspecified duration. Patient 3 was a 62-year-old diabetic female with cellulitis, osteomyelitis, exposed bone, and severe necrosis of the right heel that began several months ago. Wound care consisted of 4-20 weeks of continuous NPWT at -125 mmHg and offloading. Dressing changes were performed every 2-3 days. Patients 2 and 3 received 30 HBOT sessions of 100% oxygen at 2.4 atmospheres. The patients were disconnected from the NPWT unit prior to entering the HBOT chamber. After NPWT and HBOT were discontinued, patients were then transitioned to ORC/C/silver-ORC dressing applications every other day. Duration of ORC/C/silver-ORC dressing application ranged from 3-24 weeks.

Results: In all three cases, adjunctive use of advanced wound care treatments led to successful wound closure.