A Challenging Diabetic Foot Ulcer Addressed With a Placental ECM

Supported by Convatec.

Transcript:

Hello, everyone. My name is Dr. William Long. I practice in Simpsonville, South Carolina, part of Upstate Podiatric Group, and I wanted to present a case of a 72-year-old male with a foot ulcer. It was a decubitus ulcer. I was consulted by the hospital and the patient had a below-the-knee amputation on the left side approximately a couple of years prior to developing this decubitus ulcer.

And he developed a right decubitus ulcer and vascular was consulted, the patient did not want to undergo a below the knee amputation, therefore they consulted podiatry, they know I do a lot of wound care, well, wound healing, I'll say. So the patient was in shambles to present it nicely, his white blood cell count was 17.6, his hemoglobin was low at 7.6. And his A1C, which was on a good note, was 5.8 percent. Ejection fraction 25 to 30 percent. And a CT scan was performed. He did have osteomyelitis of the posterior calcaneal tubercle.

Again, vascular surgery had optimized this patient in May of 2022 when he still had sufficient blood flow to heal. The patient did not want an amputation of his right lower extremity. And as we all know, the mortality rate for below-the-knee amputations is about 30% after one year, can raise up to about 60% after three years and then at about 70% after five, so it's all about healing these diabetic ulcers to actually save our patient's lives.

So if you look here on the slide, a lot of eschar, again, he did have a Wagner III diabetic ulcer, so there was purulence along with the ostomyelitis of the posterior tubercle. Because there was sufficient amount of bone that could be salvaged, I did take the patient to surgery after he was optimized and I removed all of the infection as you see here. Now the posterior calcaneal tubercle is present.

We resected all of the osteomyelitis, but of course now we have this huge deficit. Well, inside the hospital, we're very limited on what we can use so therefore we did use a cadaver graft initially to cover over the the exposed bone. The patient then started to receive treatment in the office so that's where I started applying InnovaMatrix.

So as you can see here, this is in June and the InnovaMatrix has already started to get a lot of granulation in there. Again, we were working with exposed bone, and now we're getting granulation tissue over the actual surgical wound site. Again, you see this kind of scarred tissue around. Now this is debrided every time, and then we apply more on InnovaMatrix. We're about two weeks from that original kind of photo at this point and I'm very pleased and very happy the patients very happy and we're at this point starting to discuss where we're going from this point meaning getting him a prosthetic for his left lower extremity and then also applying a neuro walker. As I tell patients, there are always four things that will keep a wound from healing. One is infection. Two is circulation. Three is pressure.

So in this patient, he was having home nursing coming out and I would ensure that the four by four gauze was changed, that's all they were doing. And then also placing a pillow beneath the patient's calf to keep it in the air so nothing ever touched that heel because again pressure will stop the healing of these wounds. We move on here and I'm very proud at this point in July, July 20th, you see his entire posterior calcaneus has skin coverage.

There is this small little small eschar here on the planar aspect that is no problem whatsoever. The patient was sent to a pedorthist and a neuro walker was fabricated. The patient does have a below the knee prosthetic for his other side and is very pleased with his results.

I hope you enjoyed this presentation and if you have any questions I am available. Thank you.