(CS-087) A Case Report: Revision Chopart Amputation with Residual Osteomyelitis Treated with Cod Xenografts

Reema Naman, PGY-3, DPM – Heritage Valley Beaver; Kimberlee Hobizal, DPM, FACFAS – Residency Program Director, Heritage Valley Beaver

Introduction: Two percent of the population is suffering with chronic non-healing ulcerations leading to decreased quality of life and increased healthcare costs. Chronic wounds do not advance through the normal phases of healing. There are three types of grafts: autograft, allograft, and xenografts. Atlantic cod is an acellular xenograft with a similar structure to human skin allowing for cellular ingrowth and wound healing. The omega-3 polyunsaturated fatty acids within the cod xenograft had properties to decrease inflammation and advance the ulceration through the phases of healing.1

Methods: The patient reviewed, who had a past medical history including juvenile diabetes mellitus, osteomyelitis and chronic plantar foot ulceration for 6 months, was taken back to the operating room for a revision Chopart amputation on 9/12/2022 to remove the infected cuboid. Cod xenograft* was placed on the plantar ulceration. He underwent 2 subsequent xenograft applications in the office on 10/19/2022 and 11/08/2022. The patient was also treated with IV cefazolin from 9/12/2022 until 10/24/2022. He was offloaded and nonweightbearing within a diabetic walking boot.

Results: After revisional amputation, course of IV antibiotics, nonweightbearing status and 3 applications of cod xenograft, the patient’s plantar ulceration was noted to be healed on 11/29/2022. He presented for additional follow ups on 12/16/2022 and 1/04/2022 where the ulceration had remained healed.

Discussion: The most accepted treatment course for diabetic foot wounds with osteomyelitis is a combination of surgical debridement and antibiotics. Beieler et al. reviewed 50 patients with diabetes and osteomyelitis with ulcerations and found those whose treatment combined surgical debridement and antibiotics led to a limb salvage rate of 94%.2



Michael et al retrospectively reviewed 58 diabetic foot ulcerations for 16 weeks who had acellular fish skin graft during the treatment course. There was a mean reduction of wound surface area by 87.57% with 60.34% healed at 16 weeks. It was shown the acellular fish skin graft transitioned ulcerations from chronic to acute phase of wound healing.3



Our case study demonstrated the combination of IV antibiotics, offloading and fish xenograft over the course of 11 weeks for a chronic diabetic heel wound assisted with wound healing.