(CS-014) Healing a Chronic Diabetic Wound After Infection Derived Amputation
Friday, April 28, 2023
7:15 PM - 8:30 PM East Coast USA Time
Carmina Quiroga, DPM
Introduction: Lower extremity diabetic wounds lead to an increased rate of amputation compared to the general population. Though there are many variables that contribute to diabetic lower extremity amputation, infection and gangrene are frontrunners.ยน Infection leading to gas gangrene can not only result in limb loss but also increased mortality rates unless quickly and aggressively treated with surgical intervention, antibiotics and wound care modalities.2 Though many different methods for wound care exist, negative pressure wound therapy has continued to provide an effective mechanism for increasing granulation tissue formation. Shorter wound duration leads to decreased rates of re-infection, amputation, and health care costs to the patient.3 In this case study we provide an example where omega-3 rich fish skin grafts were utilized to aid in chronic wound healing.
Methods: We report a case where Omega-3-Rich Fish Skin grafts were utilized to aid wound closure after a gas gangrene derived partial lateral foot resection in an insulin dependent patient. Due to soft tissue loss, a large deficit persisted laterally and negative pressure wound therapy with porcine placental graft and regular debridement was not yielding positive progression of healing. After approximately five months of routine debridements and a series of applications of fish skin grafts, enough healing had occurred to allow for secondary closure of the wound in the operating room. However, dehiscence occurred due to patient non-compliance in respect to offloading. An additional surgical debridement was performed and routine in-office debridement and fish skin grafting was resumed for three months.
Results: The amputation site and area of dehiscence were healed in a matter of months despite the degree of tissue loss. The patient has now returned to work without any complications with dehiscence or re-ulceration to the area.
Discussion: Diabetic neuropathy leading to significant infection from minor trauma is a major cause of lower extremity amputation. Omega-3-rich fish skin grafts allow for expedited granulation and epithelialization of these wounds which leads to reduced risk of re-infection and reductions in more proximal amputations. This case study may hopefully provide an example of possible wound care strategy to physicians working with lower extremity amputation wounds post-infection.
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