Novel Management of Diabetic Foot Ulcers Using Injectable Micronized Dehydrated Amnion Chorion Membrane (dHACM) Allograft Tissue: Two Case Studies

Introduction: The presence of infection in a chronic diabetic foot ulcer (DFU) increases the risk of a lower extremity amputation. Since many amputations can be avoided, prompt, conservative treatment of DFUs is essential. We present two cases successfully treated in the outpatient setting with injectable micronized dHACM allograft tissue suspended in 1 ml sterile normal saline.

Results: Case 1: A 45-year-old diabetic male with peripheral neuropathy presented with a right great toe DFU that had been persisting for three weeks. Initial outpatient workup included an x-ray that confirmed underlying osteomyelitis. He was prescribed a six-week course of levofloxacin. On day 0 and day 7, the right toe ulcer underwent debridement to remove necrotic tissue and infected bone. Treatment over the first 13 days also included daily silver alginate dressing changes plus offloading. After two weeksm the DFU remained stalled and was at risk of amputation; thus, on day 14, micronized dHACM (40mg) was injected around the perimeter of the ulcer into the underlying ulcer bed. A second injection with 40 mg of micronized DHACM was repeated on day 21. By day 28, the ulcer was healed.

Case 2: A 65-year-old diabetic female S/P right trans-metatarsal (TMA) amputation developed a distal DFU persisting for three weeks prior to presentation. Preliminary workup included an ankle-brachial index of 0.6. After eight days of conservative therapy, the DFU remained stalled. Consequently, 40 mg of micronized dHACM was injected around the perimeter of the chronic DFU. Post one injection of dHACM, the DFU closed over 50 days, while continuing the original conservative topical therapy.

Conclusion: These cases illustrate that an innovative approach such as injecting micronized dHCAM around the periphery and beneath the wound bed of a stalled DFU affords a new option to utilizing micronized dHACM in scenarios where a topical application may be rendered ineffective.