(CS-081) Dehydrated Human Amnion Chorion Membrane for Hard-to-Heal wounds in the Post-Acute Care Setting

William Tettelbach, MD, FACP, FIDSA, FUHM, MAPWCA, CWSP – Executive Medical Director of Wound & Hyperbaric Medicine Service Line/Adjunct Assistant Professor, HCA Healthcare, Mountain Division/Duke University School of Medicine; Allyn Forsyth, PhD – Dir, Medical Communications & Publications, MIMEDX Group, Inc.

Introduction:
Post-acute care, which encompasses long-term hospitals, inpatient rehab facilities, home-based care, and skilled nursing facilities, is an often-underappreciated aspect of a patient’s journey to recovery. Wound care provided in the post-acute care setting can often be the critical step in shaping a favorable outcome while avoiding penalties for typically preventable events (e.g., readmission within 30-days of discharge from the hospital). Patients with advanced age, multiple comorbidities and poor mobility are especially vulnerable and dependent on quality post-acute care. The restricted access to patient care in the hospital outpatient department (HOPD) setting that happened during the COVID-19 pandemic highlighted the need for expanded wound care services outside of the HOPD setting. As a result, mobile wound care services are now gradually growing across the US. Here we describe the care provided to two complex patients using mobile care. The use of fluorescent imaging, Dehydrated Human Amnion Chorion Membrane (DHACM)* and the impact on wound size were all tracked using modern software, allowing for quality care and wound closure for challenging patients.

Methods:
A mobile onsite service** provided wound care to two patients with hard-to-heal wounds in their personal homes following care in the HOPD setting. Patient treatments, wound characteristics and wound size were tracked at each visit. The stalled wounds received standard care that included debridement and compression therapy when needed. When conservative therapy failed, DHACM was appropriately applied at weekly to biweekly intervals until wound closure was observed.

Results: Two elderly female subjects, each with multiple comorbidities were seen weekly for hard-to-heal wounds with different etiologies. A Venous leg ulcer (VLU) on the lower left leg of subject 1 was closed in 5.5 months. A DFU on the right heel of subject 2 was closed in 12 months.

Discussion: Advanced age, low mobility, and multiple comorbidities are common in the post-acute care settings. When such patients are discharged from the hospital with hard-to-heal wounds, they are often at a greater risk for infection, amputation, and an increased mortality rate. Here we demonstrate how closure of hard-to-heal wounds can be achieved with post-acute care management that integrates the use of DHACM into the post-acute care treatment algorithm.