Efficacy of Three-dimensional Acellular Xenograft* in Promoting Healing of Challenging Chronic Diabetic Foot Ulcers Penetrating to Underlying Tissues: Two Case Studies

Introduction: Diabetic foot ulcers (DFUs) pose a significant clinical challenge due to their chronic nature, frequent penetration into under- lying tissues, and associated comorbidities. A three-dimensional acel- lular xenograft* derived from porcine liver offers a novel therapeutic ap- proach to enhance healing in complex wounds. This abstract highlights two case studies demonstrating its effectiveness in promoting wound closure in chronic DFUs under challenging conditions. Cases: The first case involved a 64-year-old African American male with a chronic DFU (15.81 sq. cm) penetrating to underlying tissues, including exposed tendon, on the left foot. The wound, present for 55 days, was treated with weekly three-dimensional acellular xenograft* applications for four weeks, transitioning to biweekly applications. Off- loading protocols were maintained throughout treatment. The second case featured a 33-year-old African American male with a 24-week-old DFU (2.24 sq. cm) on the left heel. Challenges included tobacco use and non-adherence to offloading. The three-dimensional acellular xenograft* was applied weekly for the first four weeks. Standard of care, including peri-wound assessments and dressing changes, was main- tained. Wound progression was monitored weekly, focusing on changes in length, width, and depth. Results: In the first case, the wound area reduced by 75.7% by week four, despite the wound’s penetration to exposed tendon. This im- provement prompted a transition to biweekly applications, leading to a 93.7% percent area reduction (PAR) by week eight, with the wound area decreasing to 1.0 sq. cm. The consistent use of the three-dimensional acellular xenograft*, alongside standard of care and adherence to off- loading protocols, played a critical role in achieving substantial wound healing. In the second case, the three-dimensional acellular xenograft* facilitated significant healing despite suboptimal clinical conditions. By week four, the wound area had decreased by 80.4%. Although fluctua- tions occurred due to maceration and lack of offloading, the wound area reached 0.24 sq. cm by week seven, representing an 89.3% PAR. This second case demonstrated improved peri-wound conditions, including reductions in maceration, while both cases exhibited reductions in exudate over time. Discussion: These case studies demonstrate the three-dimensional acellular xenograft’s* ability to achieve substantial healing in chronic DFUs, even with underlying tissue involvement or challenging condi- tions. The first case underscored the importance of protocol adherence, while the second showcased the three-dimensional acellular xenograft’s* effectiveness under less-than-ideal scenarios. These findings highlight its versatility and effectiveness in managing complex wounds. Further research is needed to validate and optimize its clinical application.