The Use of Allografts Along with Advanced Wound Care Modalities to Aid in Closure of a Complex Diabetic Foot Wound with Exposed Deep Structures Including Tendon and Bone

Introduction: Complex diabetic foot wounds with exposed deep structures, including tendon and bone, are challenging to treat and to achieve closure. Deep wounds with exposed structures can be extremely difficult to heal and increase the risk for infection and possible loss of limb. Biologically active cryopreserved human skin allografts have been shown to be effective and safe to use in treatment for wounds with exposed tendon and bone. The author presents an extremely challenging case of a 96-year-old diabetic patient with a 4-month-old wound with exposed tendon and bone treated with a cryopreserved human skin allograft. A below-knee amputation was averted and the patient went on to full closure.

Methods: Oral and intravenous were administered. The wound underwent sharp debridement as needed, including debridement of necrotic tendon. Negative pressure wound therapy NPWT was utilized to help promote granulation tissue and to decrease the size and depth of the wound. Cryopreserved biologically active split-thickness allografts were utilized to cover the exposed bone and tendon and to help stimulate granulation tissue and wound healing. All allograft applications were performed in the wound care setting without the need for anesthesia or the associated risks of taking the patient to the operating suite.

Results: Wound closure was achieved with four applications of the cryopreserved allograft. The patient went on to full closure and a below-the-knee amputation was averted.

Conclusion: A cryopreserved split-thickness allograft is an excellent advanced wound care modality to aid in closure for wounds with exposed tendon and/or bone. In this case presentation, a 96-year-old diabetic patient with a complex diabetic foot wound with exposed tendon and bone went on to full closure averting a below-knee amputation.