Temple University School of Podiatric Medicine Journal Review Club

Editor's note: This post is part of the Temple University School of Podiatric Medicine (TUSPM) journal review club blog series. In each blog post, a TUSPM student will review a journal article relevant to wound management and related topics and provide their evaluation of the clinical research therein.

Article Title: The Use of Cryopreserved Human Skin Allograft for the Treatment of Wounds With Exposed Muscle, Tendon, and Bone

Authors: Wilson, T.C., DPM; Wilson, J.A., DPM; Crim, B, DPM; and Lowery, N.J., DPM

Journal Name and Issue: WOUNDS, Vol. 28 (4), 119-125, April 2016.

Reviewed by: Sharon Mathew, Class of 2018, Temple University School of Podiatric Medicine

Introduction

Wounds with exposed bone and tendon are a major concern for physicians due to the significant morbidity that they can cause. The primary focus of this study is to determine the efficacy and safety of a biologically active, cryopreserved human skin allograft for the treatment of wounds of this nature.

Methods

The authors performed a retrospective medical record review of patients at one hospital-based wound care center, and selected only those patients who had wounds with exposed bone, tendon, or both in the lower extremity, and had not been previously treated with a skin substitute or biologic. Ultimately, 15 patients with 15 wounds were selected, with 11 of them having exposed bone, 1 with exposed tendon, and 3 with both. Treatment of the wound included mechanical or sharp debridement (as deemed necessary by the physician) and application of the allograft. Patients were given a second graft if necessary, and if by the 4th week, the size of the wound was not reduced by more than half, another graft was applied. Wounds were covered with a bolster dressing or negative pressure wound therapy.

Results

The average size of the wounds in this study was 16 cm² ± 14 cm², and the average number of grafts applied was two. The authors found that 93.3% of the wounds were completely healed as a result of the treatment performed in this study, with granulation tissue coverage seen at an average of 36.14 days. Complete wound healing was seen in about 133 days. The authors found no adverse effects related directly to the application of the graft.

Discussion

The purpose of this study was to determine the efficacy and safety of the allograft on lower extremity ulcers that had exposed bone, tendon, or both. Efficacy was determined based on how long it took for the coverage of exposed bone and/or tendon, how long it took to achieve complete wound healing, as well as the number of grafts needed. The graft was considered effective because 93.3% of the wounds were completely healed, taking an average of 133 days, and an average of two grafts. Safety of the graft was determined by assessing any adverse reactions patients experienced as a direct result of the graft. Since there were no adverse effects noted as a direct result of the graft, this graft was considered to be safe.

Conclusion

Further investigation of this treatment should include a larger sample size, as well as controls for comparative analysis. Despite this, using a cryopreserved, biologically active human skin allograft is a safe and effective method for treating wounds with exposed bone and/or tendon.

About the Authors:

Sharon Mathew is a 4th year student at Temple School of Podiatric Medicine (TUSPM) in Philadelphia, PA. She completed her undergraduate studies at Rutgers University in 2013 with a major in Cell Biology and Neuroscience, and a minor in Public Health. Dr. James McGuire is the director of the Leonard S. Abrams Center for Advanced Wound Healing and an associate professor of the Department of Podiatric Medicine and Orthopedics at the Temple University School of Podiatric Medicine in Philadelphia.