Case Example
GRAFTJACKET® Regenerative Tissue Matrix - Ulcer Repair

Use of an Acellular Dermal Matrix as a Last Resort to Repair a Chronic, Non-healing Diabetic Foot Ulcer

Pre-Op

Post-Op | 4 weeks

INTRODUCTION
A silent epidemic within the diabetic population is the increasing number of lower extremity amputations (LEA). The American Diabetes Association estimates that 85% of all LEA are preceded by foot ulcers.¹ Some of these foot ulcers are non-healing or slow-to-heal wounds that can become infected and ultimately lead to amputation. For the clinician, it is therefore extremely important to encourage these wounds to close as quickly as possible.

PATIENT PROFILE
The patient is a 38 year-old female who initially presented with a 1-day-old ulcer over the sub left first metatarsal head. The patient has a history of uncontrolled diabetes with significant neuropathy, complications relating to an infection in her leg 5 years earlier, but an apparently intact vascular status. Initial treatment consisted of debridement (removing dead and devitalized skin and tissue), off loading, and antibiotics.

Follow-up over the next several months demonstrated progression of the ulceration, followed by regression, followed by further breakdown of the wound. At three months osteomyelitis was ruled out and additional treatment modalities used: Topical agents (Panafil®, Accuzyme®, and Iodosorb®), wound dressings (Promogran®, Oasis®, Puraply™) and Vac-assisted closure.

SURGICAL METHOD
Eight months after the initial presentation and subsequent failure to heal, GRAFTJACKET® Matrix was implemented as a last resort.

POST-OPERATIVE COURSE
At one week post-op the graft site appeared normal. At 4 weeks post-op the ulceration was closed. At 8 weeks, the ulceration remained closed and the foot had assumed a normal appearance without any erythema (reddening of the skin), or swelling.

DISCUSSION
GRAFTJACKET® Matrix is a processed acellular (not made up of cells) dermal layer which demonstrates cellular revascularization and population and soft tissue coverage in difficult-to-heal wounds. Due to the fact that the matrix is essentially free of cells or cell remnants, the material has demonstrated excellent biocompatibility in soft tissue repair. GRAFTJACKET® Matrix is a excellent alternative to grafting chronic, non-healing wounds.

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1. Sajders LJ, Reiber GE. Diabetic foot ulcers and amputations. American Diabetes Association, Inc., 2001.