Concomitant Hyperbaric Oxygen and Retention-processed Placental Grafts for Dfus

Introduction: Diabetes has become a very prevalent disease in the United States. Up to 39% of diabetic patients will develop a diabetic foot ulcer (DFU), with about 1.6 million DFUs treated each year. These wounds are very susceptible to infection with 20% of these infections leading to amputation. Sadly, the 5-year morbidity of lower limb ampu- tees is over 80%. Additionally, amputations can have a serious economic impact due to increased expenditures on surgery, post operative care, prosthetics, rehabilitation, etc. It is imperative to treat DFUs with an aggressive approach to aid in quicker healing, avoid amputation and unnecessary costs. A combination of placental membrane grafts as wound coverings with hyperbaric oxygen (HBO) therapies is an example of such an aggressive approach. This case report follows a patient treated with HBO and retention-processed full-thickness amnion/chorion (RE-AC) placental grafts resulting in great success and a fully recovered wound. Methods: A 72-year-old, male patient with a past medical history of obesity (BMI=42.1), Type 2 Diabetes, lymphedema with extensive dermatosclerosis, non-compliant OSA with pulmonary hypertension developed a R heel ulcer. During and after hospitalization, the patient underwent multiple debridements and 4 artificial grafts, with no success. The patient was started on a novel approach of HBO therapy and RE-AC placental grafts. HBO dives were 5 days a week and dressing changes were completed daily. It is important to note this patient had significant drainage due to his lymphedema. The treatment was concluded after 44 total HBO therapies and 3 RE-AC placements, resulting in complete re-epithelialization. Discussion: Approximately 40-60% of all lower limb amputations are in patients with diabetes.(3). As noted earlier, 85% of amputations are preceded by a foot ulcer. Aggressive treatment of foot ulcers can result in a 50% decrease in the amputation rate (3). Lifetime cost of an amputation is around $750,000* (4). In the case presented, the patient had a grouping of comorbid factors that made his DFU very difficult to heal. Previous attempts by other caregivers had been unsuccessful for several months. The combination of hyperoxygenation of tissues through HBO with growth factors and other mediators in the retention- processed RE-AC placental graft create a wound environment that is highly conducive to healing compromised tissues. In this patient, HBO and RE-AC were very successful in the treatment of this recalcitrant wound.