TITLE:
Limb Salvage Using Human Placental Allografts: Adding to the Reconstructive Ladder Paradigm
AUTHORS:
Stephanie Y. Ohara, Samantha A. Delapena, William H. Tettelbach, Lora Whooley, Sean F. O’Keefe, Marc R. Matthews
KEYWORDS:
Limb Salvage, Placental Membranes, Amnion, Chorion, Umbilical Cord, Allograft, Burns, Trauma
JOURNAL NAME:
Surgical Science,
Vol.13 No.1,
January
5,
2022
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® 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.