Treatment of a Refractory Trauma-Induced Diabetic Foot Ulcer Utilizing a Nano-Engineered Tissue Matrix

Chronic, nonhealing ulcers represent a continued challenge in the wound care clinic and a growing health-care concern across the United States. Trauma-induced diabetic foot ulcers present a unique challenge in this setting due to the concomitant physiological, anatomical, and biomechanical perturbations inhibiting normal wound healing processes.

The present report highlights a unique case in which a trauma-induced diabetic foot ulcer refractory to existing advanced therapies was successfully treated and closed utilizing a novel nano-engineered tissue matrix. The 65-year-old diabetic male immigrated from Russia and presented with severe bilateral lower limb deformities resulting from a land mine explosion and a persistent foot ulcer >1 year old located on the left plantar foot and measuring 2.8 cm x 1.5 cm x 0.4 cm. Upon examination, the wound was classified as a trauma-induced diabetic foot ulcer and treatment was initiated in May 2018.

Treatment with both standard dressings and multiple advanced therapies over a 10-month time period was unsuccessful, including a full course of amniotic tissue allografts. A hindfoot amputation was indicated, as had been performed on the contralateral side, but one more course of nonoperative wound treatment was attempted. A novel nanofiber tissue matrix (Restrata Wound Matrix, Acera Surgical, Inc.) capable of mimicking the structure and architecture of native extracellular matrix was then applied to the wound beginning in February 2019. The wound demonstrated marked response to repeat applications of the nanofiber matrix and subsequently achieved full closure after nine applications in June 2019.

The present report demonstrates that the nanofiber tissue matrix offers an effective alternative to other advanced wound care modalities and may provide significant clinical