Limb Salvage in Non-Compliant Type II Diabetic Patients using an Esterified Hyaluronic Acid Matrix without Split Thickness Skin Graft (STSG)

Introduction: The incidence of type II diabetes has increased to 8.6% representing nearly 21 million people in the US alone (1).  As many as 15% of diabetic patients will develop lower extremity wounds (LEW) requiring amputation (2). LEW with exposed bone and tendon offer a unique wound healing challenge. We evaluated an esterified hyaluronic acid matrix (eHAM) to salvage limbs in patients with LEW.
 

Method: Four male patients with LEWs were evaluated for HbA1c, CRP, ESR, and WBC. The eHAM was applied to the LEW, evaluated every 3-4 days, and was replaced every 2-3 weeks following minimal sharp edge debridement, as necessary. The %volume wound reduction was recorded along with the week of wound closure.

Results: Initial HbA1c, CRP, ESR, WBC were all outside the normal range of; 11.3 ± 1.1%, 135 ± 114 mg/L, 80.5 ± 23.4 mm/hr, 15675 ± 9206/uL, respectively. The initial wound volumes were 4.7 ± 2.7 cm3. NPWT alone was not effective at closing the wound during the first 3-8 weeks in 3 case studies.  A fourth case study did not receive NPWT. Following eHAM application, wound volume closure was 65% (week 2-4) and 94% (week 10-16). 

Conclusion: We conclude that eHAM is an effective limb salvage treatment for LEW with exposed bone and tendon in type II diabetic patients.  Moreover, STSG were not required for wound closure thus preventing patients from additional discomfort.  

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References (if applicable): 1. Bullard K.M., Cowie C.C., Lessem S.E., Saydah S.H., Menke A., Geiss L.S., Orchard T.J., Rolka D.B., Imperatore G. Prevalence of Diagnosed Diabetes in Adults by Diabetes Type —United States, 2016. Morbidity and Mortality Weekly Report, 2018, 67(12), 355-361

2. Deshpande A.D., Harris-Hayes M., Schootman M. Epidemiology of diabetes and diabetes-related complications. Phys Ther, 2008, 88(11), 1254-1264