Successful Upper Extremity Limb Salvage Using Cellular- and Tissue-based Products in a Patient With Uncontrolled Diabetes

Abstract

Introduction. Uncontrolled diabetes causes dysfunction in all stages of wound healing, including greatly delayed wound closure owing to impaired angiogenesis. CTPs play an important role in advanced wound care, especially in complex diabetic wounds. The 3 categories of CTP are ECMs, amniotic tissues, and composite products that combine living cells and a collagen matrix. These products are available as xenografts or allografts, or as bioengineered products. ECMs provide a biological scaffold to facilitate wound healing, and these tend to modulate the wound environment and become incorporated into the wound bed. Case Report. A right-hand dominant female with uncontrolled type 2 diabetes presented with a complex nonhealing wound of the right upper extremity; the patient was treated with CTPs after surgical intervention (incision and drainage of the abscess, open carpal tunnel release, forearm fasciotomy, and excisional debridement) for a deep forearm abscess. Exposed critical structures included flexor tendons and the median nerve. The patient received a single application of a meshed dermal regeneration template, an application of minimally processed human umbilical cord membrane, and an application of acellular fish skin, resulting in successful wound reconstruction and improved function of the right upper extremity. Conclusion. To the authors’ knowledge, this is the first described use of acellular fish skin in the setting of upper extremity reconstruction.

Acellular Piscine Dermis for Pediatric Hand Burn Reconstruction

“… 6 This is advantageous for poorly vascularized wound beds, such as the overexposed structures of the hands, which require a robust foundation of granulation tissue for definitive skin grafting. 10 Omega3, specifically, has been shown to regulate inflammation and have antibacterial properties. 6 Kerecis is decellularized and is incorporated into the body along with intrinsic structures of the piscine dermis as a scaffolding.…”

“…We have found this to be useful in complex upper and lower extremity wounds, including this case. 10 , 11 …”

“…We have found this to be useful in complex upper and lower extremity wounds, including this case. 10,11 The use of skin substitutes in the treatment of pediatric burn wounds is a viable alternative to allografts, as they are effective in promoting wound healing and reducing infection risk while avoiding the problems typically associated with allografts, including cost. 12 The use of ADM eliminates donor-site morbidity, which is helpful in pediatric patients, who require conservation of body surface area.…”

Successful Treatment of Wounds from Nonuremic Calciphylaxis with Acellular Piscine Dermis

“…2,[15][16][17][18][19] When considering ADMs, it is essential to choose the product that best aligns with the goals of the reconstruction. 10 Kerecis has become a useful tool. Unlike bovine and porcine products, there are no known pathogens that are transferred between North Atlantic cod and humans.…”

“… 5 – 8 There are also reports of its use in mucogingival procedures and in a critical upper extremity wound. 9 , 10 In vivo, this ADM promotes angiogenesis and collagen synthesis, functioning as an antiinflammatory agent that increases the speed of wound healing. 11 There is a paucity of literature regarding the use of this ADM in patients with cutaneous calcific lesions, with a single report of iatrogenic neonatal calcinosis cutis.…”