Venous Stasis and Diabetic Foot Ulcers: Case Reports

Supported by Convatec.

Transcript:

My name is Dr. James LaPolla Junior. I'm here to present a case presentation on the benefits of InnovaMatrix AC graft.

This meeting is sponsored by Convatec and considered promotional in nature. Off-label promotion of Convatec products is prohibited. 

I am the current president of the Northeast Ohio Foot, Ankle, and Wound Center. I'm on the clinical staff associated with the East Liverpool Hospital Residency Program. I'm Chief of Podiatry at St. Joe's Hospital in Warren, Ohio. Board certified in Wound Care. (Conflicts disclosed in the presentation.)

The first presentation is a venous stasis-type ulceration. It took 8 applications over a 24-week time frame to close. The patient is a 66-year-old Afro-American female with a 6-month history of a venous stasis ulcer at the left ankle. Prior to her presentation to my office, she had been treated by her PCP in addition to herself. She has not used any compression or compression boots. Patient states this is due to a skin irritant around her ulcer. She blames it on dry skin. The current working diagnosis for her is peripheral vascular disease, venous stasis dermatitis, and ulceration with a history of multiple sclerosis. Patient initially presented to my office on October 11, 2022.

Initial treatment included debridement, an alginate dressing, and (we) initiated compression therapy. It should be noted that the patient did remove her compression wraps prior to her next appointment due to the skin irritation. After 6 weeks of treatment with no significant changes in the wound size and clinical appearance, alternate and advanced treatment was then pursued. The patient's insurance did approve the InnovaMatrix AC graft on November 22, 2022. On that day, the wound measured 3.5 by 1.5 by 0.3 centimeters. On June 2, 2023, the wound was considered healed.

It took 8 grafts to close. It should be also noted that the patient's number of grafts could have been shortened to the fact that the patient had been utilizing expired Neosporin ointment to treat her own skin irritation in addition to removing her compression early. Once I discovered that she was using expired Neosporin or Neosporin products and allowed her to put a softer wrap underneath the compression therapy, the patient did keep the compression on for the extended period of time at which time we did notice significant improvement in the healing of the wound.

You can see the pictures above. The first documented picture that I was able to take on this patient was in January of 2023. The measurements are stated there by the ruler and then final healing was noted on June 2, 2023.

The second case I wish to present today is a diabetic foot ulcer case. (The) patient required 4 applications of the matrix graft. Time to close was 8 weeks. Patients a 60-year-old diabetic male that was initially seen as a surgical consultation at a local hospital due to infection from a surgically implanted device. This device had been used prior to rebalancing the patient's foot. The patient has had the ulceration prior to the surgery for several months.

Once I was consulted, a CT scan was ordered showing lucency around the implant, which was significant for its removal and indicated for its removal. We got medical clearance prior to the surgery, and the patient agreed to the procedure. Upon discharge from the hospital and completion of the surgical procedure, we initiated our postoperative treatment, which included good wound care postoperatively in addition to offloading.

After a series of office visits, debridement and antibiotic-based dressings, we then discussed advanced wound care with the patient. The patient was agreeable to pursue such treatments and we educated the patient on the ins and outs of the InnovaMatrix graft. (The) patient's comorbidities are diabetes, also arthritis in both hips, has had bilateral transmetatarsal amputation secondary to PVD and complications of the diabetes. Prior treatments included surgical debridements, both at a local wound center and in the hospital. All prior hospitalizations records were not available. Patient post-discharge from the hospital did undergo offloading with a total contact cast in addition to periodic wound debridements and cleansing.

After the first application, total contact cast, and the patient showing that he is able to ambulate with that cast we did finally get approval for graft application and it was then pursued. January 11, 25, and February 1, we retreated the wound with application of that cast ,and then the graft, as I said earlier, was approved at the time of the initial wound application. The measurements were 2.5 by 2.5 by 0.2 centimeters.

At this time, we did apply 3 applications of the graft, in addition to securing the graft, and application of the total contact cast to help the offloading. The wound did heal. We did also maintain offloading, and it was shown that once the wound healed, it did remain healed.

Basically, the picture does show the wound's representation on the initial graft application, measurements are noted, and the patient wound does have the appearance of visually being clean. And here, after the second application time, you see the wound is reducing in size. There was one little area of small purulent drainage.

This was also debrided upon application of that  graft. At this time, after the grafts, after the number 2 graft application, you can see that the localized abscess had resolved. The wound was still responding to treatment loading and the graft and the size has reduced.

After completion of graft number 3, we see that the wound is completely healed. There's a small area of very thin epithelial layer. I did go ahead and apply one more graft just to secure to make sure that we did get final closure and a good healthy epithelial base and tissue base for this patient, in addition to the application of a total contact cast.

(The) patient returned, showing the fact that the wound did remain healed and there is no grafting at this time. Also during this process, we started the patient on authorization to get diabetic shoes with offloading inserts to maintain stability, balance, and the healed ulcer site for the patient's foot. Again, these are further pictures show that the wound has remained healed.

We did reapply a cast one time. The patient had to go through a stress test prior to being authorized to go through a hip surgery, but the graft was not applied. And then the final picture, again, on June showing that the wound was healed to the satisfaction of the orthopedic surgeon. And the application of a total contact cast was not required at this time prior to the patient's hip surgery. Thank you.