The Use of Decellularized Dermal Allograft in Conjunction With Endovascular Revascularization Promotes Limb Salvage

Introduction: There are currently 30.3 million Americans diagnosed as having diabetes, and a quarter of them will develop a diabetic foot ulcer in their lifetime. Individuals with diabetes frequently develop peripheral vascular disease (PVD) and have a 2- to 4-time higher risk than patients without diabetes. Concurrent diabetic foot ulcers and PVD increases the risk of major limb amputation in this patient population, as well as the 5-year mortality rate. The use of a next-generation decellularized dermal allograft (DDA) in conjunction with endovascular revascularization can significantly decrease wound healing times, thus preventing limb loss, improving quality of life, and reducing overall cost.

Purpose: This case study aims to demonstrate the efficacy of DDA in conjunction with endovascular revascularization to promote limb salvage.

Materials and Methods: Patient A. A 74-year-old man with diabetes and PVD presented with a nonhealing wound, resulting in transmetatarsal amputation that failed to heal. He subsequently underwent right lower extremity angioplasty with wound debridement and placement of DDA. Patient B. A 64-year-old woman with diabetes and PVD presented with a nonhealing ulcer of the left shin, which had previously failed split-thickness skin grafting (STSG). She subsequently underwent left lower extremity angioplasty with ulcer debridement and placement of DDA.

Results: Patient A, treated with DDA in conjunction with endovascular revascularization, showed significant improvement in the first 4 weeks, with a reduction in surface area of 57% and development of robust granulation tissue. He subsequently underwent a STSG at the 6-week mark and demonstrated full healing within 10 days. Patient B, also treated with DDA in conjunction with endovascular revascularization, exhibited a reduction in wound surface area of 66% in the first 4 weeks and had complete wound healing within 8 weeks. Additionally, her ankle-brachial index in her left lower extremity improved from 0.6 to 0.95 postoperatively.

Conclusions: The use of a next-generation DDA demonstrated significant improvement in 2 patients with diabetes and PVD and multiple comorbidities. Given its efficacy in 1 application, DDA provides an effective option that should be strongly considered as an adjunctive treatment to facilitate rapid improvement of wounds, ultimately allowing closure of soft tissue defects and reducing the expense of diabetic limb salvage.

This poster was presented at the 2019 Amputation Prevention Symposium in Chicago, Illinois, August 14-17. To learn more about the AMP Symposium, visit the conference website.