Limb Salvage Using Human Placental Allografts: Adding to the Reconstructive Ladder Paradigm

Abstract

Human placental allografts are the latest treatment modalities for diabetic ulcers, chronic wounds, limbs, and tendons for healing cascade and promoting granulation tissue coverage. Purion ^&reg processed dehydrated human amnion/chorion membrane allografts (dHACM), decellularized human collagen matrix (dHCM), dehydrated umbilical cord (dHUC) and micronized dehydrated human amnion/chorion membrane allografts (mdHACM) have been the newest modality used to salvage injured human extremities with tendon and bone exposure. A 53-year-old male was assaulted and sustained second and third degree burns to both legs. The left extremity had a 9.5% total body surface area (%TBSA) burned. The right extremity had a 5.5% TBSA and three exposed tendons (Achilles/flexor digitorum longus/tibialis anterior), muscles, talar and tibial bones. Bilateral extremity pedal pulses were present, and all toes had less than two second capillary refill. Sensation, motor, and strength were normal. During the 48-day-hospital stay, the patient had eight operations: tangential excisional debridements of necrotic tissue with weekly wound dressing applications of dHACM and dHCM, on both legs. In addition, dHUC was applied over the exposed tendons on weeks 2 - 5. The exposed tendons were injected with mdHACM on weeks 4 and 5. Negative pressure wound therapy was applied at 125 mmHg for fourteen days over the wound surfaces covered with a nonadherent dressing, 3% bismuth tribromophenate petrolatum dressing with a glycerol-hydroxyethyl cellulose lubricant. At discharge for rehabilitation, 90% of the split-thickness-skin-graft (STSG) was viable over the right ankle joint, tendons and bone. Use of human placental allografts prevented the need for myocutaneous flap coverage or amputation of the right foot.