Unique Surgical Technique Used to Treat Recalcitrant Pre-Tibial Ulcerations: A Case Series

Problem: Trauma is a common occurrence in the lower extremity. Pretibial lacerations resulted from trauma may evolve into chronic wounds with worsening infections if not treated properly. There is a limited amount of literature on the presentation and treatment of recalcitrant pre-tibial ulcerations (PTU). The aim of this study is to present a novel surgical treatment methodology that successfully managed recalcitrant PTUs.

Methods: We conducted a retrospective chart review of patients who presented with PTUs. All wounds underwent aggressive debridement. Further fenestrations were made around the wound periphery and the wound center using a hypodermic needle. One application of an antimicrobial acellular dermal tissue matrix derived from fetal bovine dermis (**FBADM) was used to adhere tightly onto the wound bed. A uniform multilayer compression dressing was then applied.

Results: Three PTU patients with pre-existing comorbidities were included. Each wound was caused by mechanical trauma and deteriorated into a refractory ulceration despite initial conservative treatment using over-the-counter medication. The ulceration had been present for more than 6 months at the time of admission. All ulcers exhibited local infection of cellulitis, hematoma, and a collection of purulent fluid. None of the wounds had any signs of radiographic osteomyelitis. After treatment, all wounds successfully healed within 4 months. The application of the allograft led to wound reduction by 75%, 66.7%, and by 50% in 28 days respectively.

Conclusion: The combination of a novel fenestration method and an antimicrobial FBADM successfully healed recalcitrant PTUs in high-risk patients. 

Trademarked Items (if applicable): Product Notation: **FBADM = Primatrix® Dermal Repair Scaffold, Integra LifeSciences Corp., Princeton, NJ

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