Combining the Benefits of Collagen and Negative Pressure Wound Therapy to Heal a Chronic Diabetic Foot Ulcer

A Case Report

Jeffrey D. Lehrman, DPM, FASPS, MAPWCA, CPC

Disclosures

Wounds. 2020;32(3):E11-E13. 

In This Article

Case Report

A 34-year-old man with a history of type 1 diabetes and Charcot neuroarthropathy presented with a chronic DFU of the right plantar medial surface. No sign of infection was present. The ulcer had persisted for 6 months; previous treatment consisted of efforts to offload pressure with a surgical shoe and removable cast boot. The wound also was treated with topical therapies, including clostridial collagenase, human platelet-derived growth factors (PDGFs), and 6 applications of a human amniotic membrane allograft. The initial assessment revealed a hemoglobin A1c of 9.2, palpable pedal pulses, and no indication of peripheral artery disease. Noninvasive arterial Doppler showed normal ankle-brachial index and normal segmental pressures. At the initial visit, the ulcer measured 3.8 cm x 3.7 cm x 3 mm (Figure 2).

Figure 2.

Day 0: wound at baseline.

The DFU was debrided of hyperkeratotic margins and NPWT utilizing nondisposable durable medical equipment was commenced at -125 mm Hg continuously. All debridements were sharp debridements using a scalpel blade. Then, an advanced collagen matrix wound contact layer containing alginate and designed with uniform perforations to facilitate removal of exudate was applied to the wound bed (Figure 1). The NPWT sponge and secondary dressings were changed 3 times per week. The patient was instructed to use crutches and keep weight off the affected foot as much as possible. The patient returned to the clinic on day 7 and then every 2 weeks for the remainder of his care. After the first week, debridement was performed every 2 weeks, and the collagen wound contact layer dressing was changed weekly with the application of NPWT.

Wound healing progressed with the previously described treatment regimen of biweekly debridement and weekly application of collagen wound contact layer with NPWT. On day 35, the total wound area had decreased by 91%, measuring 3.2 mm x 1.2 mm x 1 mm (Figure 3).

Figure 3.

Day 35: wound with 91% reduction.

Assessment on day 63 showed full closure of the wound had been achieved (Figure 4). The patient was advised to begin utilizing a Charcot Restraint Orthotic Walker (Scheck & Sirees, Oakbrook Terrace, IL) to prevent reoccurrence. The wound remained healed at his 18-month follow-up visit.

Figure 4.

Day 63: wound demonstrating full closure

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