Allograft Adipose Matrix Application in Diabetic Foot Ulcerations

Introduction: With osseous resection procedures in diabetic foot ulceration management, a large void of soft tissue is often left behind. This can lead to abscess formation, infection, or other post-operative complications [1]. It has been advocated that adipose allograft can not only fill the voids left after large osseous resection in osteomyelitis and Charcot surgeries, but can help promote healing through growth factor secretion and differentiation into keratinocytes and fibroblasts [2-6]. One systematic review noted the benefit of combining an allographic adipose matrix with platelet rich plasma to expedite wound healing [7]. However, the majority of studies focus on the cutaneous wound repair, with only a few studies examining adipose graft injection under the epidermis as a wound healing modality [7]. This current study is a 5-patient cohort quantitative case study examining the use of allograft adipose matrix in diabetic foot ulcerations after surgical intervention with large soft tissue voids.

Methods: This case series included 5 people who had recurrent ulcerations that failed previous standard wound care regimens. Approximately 1.5-3 cc of adipose tissue matrix was injected into the wounds after thorough surgical debridement subsequently closed. Patients were followed in a private practice or at a Wound Care Center for weekly assessment and standard treatment protocols until complete closure was achieved.

Results: All five patients healed after allograft adipose matrix application. The average time to heal was 4.8 weeks (range 2-9 weeks).

Wound area decreased by an average of 8.78 cm2 (100% area reduction) and wound volume decreased by an average of 7.46 cm3 (100% volume reduction). One patient had a recurrent ulceration after increasing her activity level, which subsequently healed with standard wound care.

Discussion: The allograft adipose matrix utilized in this study was successful in healing all patient wounds. Authors believe that this matrix allows for successful wound healing in diabetic foot ulcerations with large post-surgical deficits due to its secretome, angiogenic, and differentiation abilities [3-6]. Allograft adipose matrix can be utilized to fill large post-surgical voids with primary or delayed primary closure operative courses and promote healing difficult diabetic foot ulcerations.