Using Pctm To Prevent Further Limb Loss In Diabetic Patients Post Bka
Nora F. Dunlap, MS, Suzanna Fitzpatrick, DNP, Megan Carroll, MS, Khanjan Nagarsheth, MD.
University of Maryland Medical Center, Baltimore, MD, USA.
OBJECTIVES: In the United States, there are over 70,000 amputations performed due to diabetes (DM) annually. Of those amputations 15-30% will have a major complication in the post-operative period such as dehiscence, wound disruption, superficial surgical site infection, or deep surgical site infection which can lead to further limb loss. Additionally, wound complications result in nearly 20,000 preventable deaths and correlates with an excess of 3 billion dollars in healthcare dollars annually. We present a case series of four patients with DM and peripheral arterial disease (PAD) who had non healing wounds following below the knee amputation (BKA) that then had placental connective tissue matrix (PCTM) placed to heal the wounds and thereby prevented further limb loss and have since healed their wound.
METHODS: A retrospective chart review identified 4 patients after a 6-month period at an intercity hospital who had DM and PAD who were status post BKA with complicated stump wounds. Charts were reviewed for demographics and risk factors, wound size, number and type of applications of biologic dressings applied, time to wound healing, and overall functional outcome.
RESULTS: All the patients (N=4) underwent BKA PAD and have DM. The mean age of these patients was 59 years (range 47-69 years). Cardiovascular disease was present in 50% (2/4), hypertension was present in 75% (3/4), and end stage renal disease was present in 50% (2/4) of the patients. History of failed prior lower extremity revascularization was present in 100% (4/4) of the patients along with tissue loss and or gangrene. The mean number of applications of PCTM was 4 (range 1-8). Additionally, traditional adjunctive therapies such as wet to dry dressings, chloropicrin, and Santyl were also used along with weekly debridement to assist with healing.
CONCLUSIONS: The healing of residual limb wounds is necessary to prevent further limb loss and improve quality of life. In cases with severe PAD and DM with tissue loss, PCTM can be used to heal the wound who had failed standard post-operative wound care. Providers should consider utilizing PCTM when a patient has failed conservative therapy following a BKA.
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