The Utilization of a Next-Generation Decellularized Dermal Allograft to Facilitate Closure of a Complex Venous Leg Ulcer

Introduction: The number of individuals with venous leg ulcers (VLU) in the United States continues with up to 5% of the population over 65 years of age and 1.5% of the general population affected. Additionally, the estimated cost of treating VLU is approximately $3 billion a year, which does not take into consideration the indirect costs such as disability and lost workdays, which can reach up to 2 million days per year (Chi and Raffetto, 2015).

Objective: The aim of this complex patient case study was to evaluate the clinical and economic efficacy of VLU management that consisted of a next-generation decellularized dermal allograft (DDA), in conjunction with standard of care.

Patient Information and Prior Management: A 63-year-old male with history of peripheral neuropathy, COPD, and diverticulitis treated by primary physician with antibiotics for suspected infection to lower extremity. This was followed by two hospital admissions (within 30 days) for left leg edema due to possible infection. Treatment consisted of conservative management. On the second hospital admission, his symptoms worsened, resulting in a podiatry consult. 

Method: On Day 2 of the second hospitalization, the patient underwent incision and drainage of multiple abscesses and debridement of necrotic fascia. DDA was applied in the OR providing immediate coverage, followed by an Unna boot for compression.

Results: With one application of DDA, in conjunction with an Unna boot, there was significant improvement with a 91% reduction in surface area in eight weeks and closure in five months. There were no further hospitalizations or surgical procedures.

Conclusion: One application of DDA demonstrated significant healing in a patient with a complex VLU and extensive past medical history. Given its clinical efficacy, this DDA should be considered as an effective means for facilitating closure of soft tissue defects, as well as reducing the overall economic cost to manage VLUs.