(CS-120) Treatment of a Traumatic, Complex Wound Using Ultra-Thick Amniotic Membrane Allograft

Introduction: Lower extremity trauma accounts for 32% of all motor vehicle accident injuries.¹ Often times, these patients present with traumatic cavity wounds with extensive tissue loss. These complex wounds are particularly difficult to treat as they are more susceptible to infection, necrosis, and osteomyelitis, which are risk factors for limb loss.^{2, 3} As a result, adjunctive treatments are often used to expedite wound healing and reduce the risk of complications. Cryopreserved amniotic membrane (AM) derived from the umbilical cord is one such treatment modality that has been increasingly used in wound management due to its inherent pro-regenerative properties.^4-6

Methods: A 39-year-old male was involved in a high-speed motorcycle accident and presented with multiple traumatic injuries. The injuries included ipsilateral open fractures of the femur, tibial shaft and plafond, femoral neck fracture, and a large complex wound nearly circumferential around the knee. Once the wound was debrided and partially closed, a 11x9x4 cm wound remained with significant soft tissue loss. The posterior knee wound had exposed Sciatic Nerve, Popliteal Artery, and hamstring tendons. The patient had two debridements along with skeletal fixation of his fractures. On day 3, an ultra-thick AM allograft† was placed at the base of the open knee wound, and negative pressure wound therapy (NPWT) was administered with constant suction. On Day 10, an additional AM† was sutured over the wound to promote epithelialization.

Results: Robust granulation tissue was noted 6 days following the initial application of AM with NPWT, at which time another AM was applied. At 10 weeks, the base of the wound became flush with the healthy edges, and epithelialization was noted at the borders. Continued epithelialization was noted at 13 weeks, and range of motion (ROM) of the knee was 0-75 degrees despite not performing physical therapy. At 34 weeks, the wound had completely epithelialized, and the knee demonstrated painless ROM of 0-130 degrees.

Discussion: Use of ultra-thick AM allograft was shown to support wound closure for a traumatic, complex wound over a joint; that had an exposed nerve, artery, and tendons. AM can be used for complex wounds over joints, with expected retention of physiologic ROM.