title: Use of a human acellular dermal wound matrix in patients with complex wounds and comorbidities.
abstract: OBJECTIVE
  Rising prevalence of obesity and uncontrolled diabetes mellitus has resulted in an increasing number of patients with multiple comorbidities who require treatment for chronic complex wounds. Because patients with diabetes and foot ulcers may have a higher risk for amputations, techniques that facilitate complex wound healing and prevent limb amputation are desirable. Here, we investigate a limb preservation strategy that includes application of a human acellular dermal wound matrix (HADWM).
  
  
  METHODS
  Medical history, physical examination and full wound assessment were completed for all patients. Systemic antibiotics and appropriate offloading were prescribed as needed. Wounds were debrided to create a bleeding bone and/or wound base for HADWM (Graftjacket regenerative tissue matrix, Wright Medical Technology, Inc., licensed by KCI, an Acelity company, San Antonio, TX). Healing progress was monitored over four weeks with weekly postoperative visits. 'Healed' was defined as full epithelialisation without drainage.
  
  
  RESULTS
  Lower extremity ulcers, 16 in 13 patients, were treated with HADWM between May 2004 and July 2013. The median patient age was 76 years (range: 38-90). The average number of comorbidities was three per patient, while 6 (46%) patients had ≥4 comorbidities. Diabetes mellitus (92%) and peripheral vascular disease (77%) were the two most common. All 16 (100%) wounds healed without complications. There were no recurrences in the 11 wounds of the nine patients available for follow-up. Of these patients two had previously advised to receive major leg amputations retained functional limbs.
  
  
  CONCLUSIONS
  The results in this small study reflect our practice's 10-year experience using HADWM as part of a limb preservation strategy.
authors.affiliation: Division of Podiatry, Aventura Hospital and Medical Center, Aventura, FL.|School of Podiatry, Barry University, Aventura, FL.
authors.forename: M L
authors.initials: ML
authors.lastname: Williams
authors.affiliation: Division of Podiatry, Aventura Hospital and Medical Center, Aventura, FL.|School of Podiatry, Barry University, Aventura, FL.
authors.forename: J E
authors.initials: JE
authors.lastname: Holewinski
mesh_terms: D062088:Acellular Dermis; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D017719:Diabetic Foot / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D016038:Skin Transplantation / Q000379:methods*; D014945:Wound Healing / Q000502:physiology*
keywords: complex wounds; diabetic foot ulcers; human acellular dermal wound matrix; lower extremity ulcers