Closed Trans Metatarsal Amputation Treated with Bovine Dermal Collagen Matrix as Wound Healing Adjunct

Introduction: Trans metatarsal amputation (TMA) is commonly performed to address complications of diabetic foot ulcers, including in- fection and ischemia. The healing rates and associated complications fol- lowing closed TMA are critical factors in determining the success of the procedure and the subsequent outcomes for patients. (1) We present a case of closed trans metatarsal amputation utilizing a fibrillar particulate collagen matrix as a wound healing adjunct. Bovine dermal collagen ma- trix* is an absorbent extracellular matrix (ECM) comprised of Type I and Type III bovine collagen that closely resembles the human body’s native collagen and is designed to support the wound healing process. Fibrillar collagen derived from bovine dermis is biocompatible, biodegradable, and is used in this case as a wound healing adjunct. Methods: 83-year-old male with type 2 diabetes was admitted with infected diabetic foot ulcer. CTA showed occlusion to ATA bilaterally. Distal tissue and bone were found to be non-salvageable. Results: Trans metatarsal amputation with primary closure was per- formed in an 83-year-old comorbid male following infected ischemic foot ulcer. Bovine dermal collagen matrix* was utilized under the surgical closure to provide a collagen scaffold to aid and maintain wound healing. Time to heal was 12 days. Surgical wound closure and strength were maintained without complications upon follow up at days 49 and 83. Discussion: The results of this case show efficacy of bovine dermal col- lagen matrix* following closed trans metatarsal amputation in a diabetic patient with comorbidities. Bovine dermal collagen matrix* provides a collagen scaffold like human native collagen and is known to sequester excess proteases away from the wound bed, allowing blood and new vessel formation to integrate within its scaffold. Bovine dermal colla- gen matrix* contains intrinsic hemostatic properties to control minor bleeding and is 100% resorbable through normal metabolic pathways. When challenged with a hard to heal wound after closed trans metatarsal amputation, bovine dermal collagen matrix* showed success in maintain- ing a closed incision without wound complications. *HELIOGEN, Mimedx, Inc