A Novel Combination Approach to Severe Burn Injuries Using Fetal Bovine Dermis and Human Amniotic Membrane in Sequence: A Case Study

Burn wounds of the feet are considered major burns, with a high complication rate and significant morbidity, even in non-diabetic patients.1 Diabetic patients are known to experience more infections even in clean wounds and to heal more slowly than nondiabetic patients, especially in the extremities.2,3 Wound infection often leads to amputation4. Therefore, there is a need to develop effective treatment therapies for severe burn injuries in the diabetic population.

The patient is a 54-year-old male with diabetes, who presented with cellulitis that encompassed nearly the entire right forefoot, hindfoot, ankle, and the distal half of the right leg. The etiology of the wounds was a combination of deep tissue cold thermal injury and a superimposed third-degree burn from a blow torch. A course of antibiotics was started immediately. The patient then underwent surgical debridement through deep fascia to the level of the extensor digitorum longus tendon. After hemostasis was achieved, three 8cm x 8cm meshed fetal bovine acellular dermal matrix (**FBADM) grafts were applied and secured to the wound with sutures. Three weeks after the initial treatment, a second debridement was performed, subsequently a 10cm x 10cm dehydrated amniotic membrane allograft (…DAMA) was applied.

Three weeks post-FBADM application, 90% granulation was observed without any remaining exposed tendon. The patient was followed closely and several additional sharp debridements were performed at the office. No additional grafts were required to achieve full granulation of the wound after DAMA application. A4 months after initial graft application all wounds were completely epithelialized and the patient was satisfied with the outcome.

It is paramount that diabetic patients with foot burns receive immediate in-hospital treatment with aggressive serial debridements. The combination therapy of FBADM followed by DAMA represents a potent therapy regimen for these complex, limb-threatening lower extremity wounds.

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References (if applicable): 1. Zachary LS, Heggers JP, Robson MC, Smith DJ, Maniker AA, Sachs RJ. Burns of the feet. The Journal of burn care & rehabilitation. 1987 May 1;8(3):192-4.
2. Goodson WH, Hunt TK: Wound healing and the diabetic patient. Surg Gynecol Obstetr 149:600–608, 1979 11.
3. Morain WD, Colen LB: Wound healing in diabetes mellitus. Clin Plast Surg 17:493– 501, 1990
4. Levin, ME. Pathogenesis and management of diabetic foot lesions. In: Levin ME, O’Neal LW, eds. The Diabetic Foot, 5th edn. St. Louis, MO., USA: C.V. Mosby Co. 1988: 16-19.