Use of Dehydrated Amnion/Chorion Membrane (dACM) in a Slow Healing Trauma Wound

Background: Allograft skin substitutes are currently approved for reimbursement by Centers for Medicare and Medicaid Services (CMS) and most insurances for venous leg ulcerations and diabetic foot ulcers. Use of allograft skin substitutes for trauma wounds has not been approved for reimbursement to date, but may be beneficial in optimizing wound healing in trauma injuries. The aim of this case study is to report the use of dehydrated amnion/chorion membrane (dACM) in the treatment of a slow- healing chronic leg wound secondary to trauma.  

Case Study: 85 year old female with multiple challenges to healing, including body mass index of 33.4, peripheral vascular disease, chronic lower leg edema, and warfarin therapy sustained a laceration/hematoma on the middle third of the right lower leg during a low energy fall.  The original wound measurement, 10 days post-trauma, was 5 x 15 x 0.1 cm.  After nine weeks of wound care including debridements and advanced wound care therapies at another facility, the patient presented with a chronic wound 4.4 x 10.0 x 0.1 cm with a necrotic base.  Ankle brachial index measurements were evaluated to be 0.61.  The wound was debrided of hematoma and devitalized tissue to a final size of 5 X 7.5 X 1.3 cm. dACM  therapy was initiated followed by wound gel, versatel, steri-strip, foam dressing and tubigrip per our protocol. A series of 10 weekly dACMs per protocol were applied.  By week 20 post injury (11 weeks after the last application) the wound was completely healed despite her many comorbidities.

Conclusion: The use of dACM, which consists of extracellular matrix proteins, growth factors, and cytokines, appears to be advantageous in the management of slow-healing trauma wounds. This patient improved with the use of dACM, but more research is needed to evaluate the benefits of dACM in trauma wounds.