Stage IV Perineal Pressure Ulcers in Immobile Patients Treated With Surgical Flap Closure Augmented With Cryopreserved Placental Membrane Containing Viable Cells.

INTRODUCTION: Surgical closure of late-stage pressure ulcers (PUs) poses challenges in the immobilized population due to the high rate of complications, including infection, dehiscence, and recurrence. Muscle flap closure is the standard treatment for chronic, late-stage (stage 4) PUs, characterized by the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel as full-thickness tissue loss with exposure of bone, tendon, or muscle. OBJECTIVE: The aim of this study is to evaluate the outcomes associated with the use of a cryopreserved placental membrane containing viable cells (vCPM) graft for the augmentation of surgical flap closure in nonhealing perineal ulcers. MATERIALS AND METHODS: Four paraplegic patients (2 men, 2 women; average age, 61 years; range, 44-77 years) with stage IV PUs (ischial, gluteal, and sacral areas) with a mean duration of 4 years (range, 0.5-10 years) received muscle flap closure augmented with vCPM. Following surgical debridement, vCPM was placed between the wound bed and muscle flap closure prior to skin closure. Patients were kept offloaded in fluid-air beds for 6 weeks followed by a gradual return to mobilization. RESULTS: All 4 patients achieved complete wound closure in an average of 7 weeks (range, 6-8 weeks) without complications or recurrence. All patients demonstrated complete take of the muscle flap and maintained their closed wounds for an average follow-up of 12 months. CONCLUSIONS: Preliminary clinical results indicate vCPM supports surgical wound closure of chronic perineal PUs in immobile, high-risk patients. In an effort to decrease postoperative recovery time and reduce complications, vCPM may be beneficial for patients undergoing perineal muscle flap closure.

Surgical Application of Viable Cryopreserved Placental Membrane for the Treatment of Chronic Wounds in 12 High-risk Patients.

Treatment of lower extremity ulcers remains a challenge to physicians and surgeons. These wounds lead to an increased risk of amputation and increased mortality rate and must be treated aggressively, in many cases requiring surgical debridement, to prevent these complications. The objective of this retrospective case series is to evaluate the safety and efficacy of a viable cryopreserved placental membrane (vCPM) in 12 patients with 16 wounds of mixed etiologies when surgically debrided and augmented with vCPM 1 time, followed by standard of care (nonadherent dressing, gauze, and compression) until healed. The results of this case series demonstrate that the surgical application of vCPM can be used as an alternative treatment for high-risk patients with chronic lower extremity wounds.

Use of Viable Cryopreserved Umbilical Tissue for Soft Tissue Defects in Patients With Gas Gangrene: A Case Series.

INTRODUCTION: Gas gangrene is a rapidly progressive bacterial infection leading to necrosis that usually develops as a result of trauma or postoperative complications. This condition requires early diagnosis with immediate surgical intervention. With a poor prognosis, a high incidence of amputation, and comorbidities such as diabetes and peripheral vascular disease, patients with gas gangrene are put at further risk for surgical complications. OBJECTIVE: This case series reports the clinical outcomes of using a commercially available viable cryopreserved umbilical tissue (vCUT) in the surgical management of 10 patients (9 males, 1 female) with acute lower extremity gas gangrene. MATERIALS AND METHODS: All 10 patients had aggressive debridement and irrigation, followed by an intraoperative application of vCUT to cover the large, complex wounds with exposed bone, tendon, and soft tissue, which was fenestrated and sutured to the surrounding skin edges. RESULTS: The average wound size following debridement was 45.9 cm2 (range, 8 cm2-105 cm2). Average percent area reduction of the wounds at 4 weeks post-vCUT application was 68.4% (range, 49%-99.5%). The average length of hospital stay was 9 days (range, 2-16 days), and postdischarge patients were treated with negative pressure wound therapy and standard of care (nonadherent dressing, dry gauze, and mild compression) until wound closure was achieved (average, 3.3 months [range, 1.25-4.5 months]). With a 1-time application of vCUT, all patients reached complete wound closure with decreased time to closure, fewer complications, and a shorter duration of hospitalization as compared with traditional inpatient management of gas gangrene (incision and drainage with staged procedures). CONCLUSIONS: The positive clinical outcomes indicate that vCUT may be an effective aid as an intraoperative application to cover wounds following aggressive debridement in the presence of gas gangrene.

Clinical Outcome of Achilles Tendon Repair Using Viable Intact Cryopreserved Umbilical Tissue Versus Standard of Case.

INTRODUCTION: Repair of acute Achilles tendon ruptures is complicated by the severity of the rupture, quality of the tendon, and length of the defect. The adjunct use of biologics (eg, viable umbilical tissue) may provide additional support and reduce postoperative inflammation, adhesions, and fibrosis. OBJECTIVE: The aim of this study is to review the outcomes of Achilles tendon rupture open repairs with viable cryopreserved umbilical tissue (vCUT) compared with patients treated with standard of care only. MATERIALS AND METHODS: Four patients (average age, 59 years; range, 55-65 years; 2 male, 2 female) with acute Achilles tendon injuries treated surgically with vCUT were selected. The repairs were augmented with vCUT sutured over the tendon ends (Wharton's jelly side towards the tendon) with absorbable sutures. RESULTS: Patients remained nonweight-bearing after surgery for 4 to 6 weeks followed by a gradual return to ambulation. All patients maintained durable skin closure, had minimal scarring and edema, and were able to return to work in 8 to 10 weeks. All 4 patients returned to their preinjury activity level without pain or loss of function. There were no vCUT-related complications or adverse events. CONCLUSIONS: Clinical outcomes of this study support the use of vCUT for augmentation of Achilles tendon repair.