Successful Upper Extremity Limb Salvage in an Uncontrolled Diabetic Patient with the Use of Cellular and Tissue Based Products

Uncontrolled Diabetes Mellitus causes dysfunction in all stages of wound healing.  Wound closure is greatly delayed due to impaired angiogenesis in these patients.  Cellular and tissue based products (CTP) play an important role in advanced wound care, especially in complex diabetic wounds.  The three categories of CTP’s are Extracellular matrices, Amniotic tissues, and those that combine living cells and a collagen matrix.  These products are either available as xenografts, allografts, or as bioengineered products.  The ECMs provide a biological scaffold to facilitate wound healing, and these tend to modulate the wound environment and tend to become incorporated into the wound bed.

In this report we discuss a right-hand dominant female patient with uncontrolled type 2 diabetes mellitus with a complex non-healing wound of her right upper extremity after surgical intervention for a deep forearm abscess, including incision and drainage of the abscess, open carpal tunnel release, forearm fasciotomy, and excisional debridement.  She had exposed critical structures including flexor tendons and median nerve in the base of the wound.  

We successfully performed limb salvage on an initially non-functional upper extremity.  The products used included a single application of a meshed dermal regenerative template*, one application of minimally processed human umbilical cord membrane**, and a single application of acellular fish skin***.  This patient benefited from optimal use of multiple cellular and tissue based products to manage a complex diabetic wound, which resulted in successful wound reconstruction and improved function of her right upper extremity.  To our knowledge, this is the first description of using acellular fish skin in the setting of upper extremity reconstruction with exposed tendon and nerve.

Trademarked Items (if applicable): *Integra
**Avive soft tissue membrane
***Kerecis Omega3

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