(CS-111) Application of Desiccated Human Amniotic Membrane (DHAM)* on Nonhealing Femoral Ulcer for a Wheelchair-bound Patient with Ataxia and Traumatic Brain Injury

Samera Taki, BS – Clinical Research Coordinator, Mobile Doctor Medical Clinic

Introduction:

Desiccated human amniotic membrane (DHAM) is a chorion-free allograft derived from amniotic membrane tissue. This case evaluates treatment outcomes in a patient with a nonhealing, cellulitis-induced ulcer on the right medial thigh that had not responded to conservative wound care. Patient is a 72-year-old, wheelchair-bound male with ataxia, traumatic brain injury, benign prostatic hyperplasia, and obesity. Need for expedited healing arose as the wound persisted and risk of cellulitis recurrence and/or osteomyelitis developed.

Methods: Patient presented with a nonhealing, full thickness ulcer on the right medial thigh that developed as a result of cellulitis six weeks prior and persisted despite debridement of the site of cellulitis and localized standard wound care three times per week (silver alginate, bordered foam, offloading). At baseline visit, wound measured 2.0cm x 2.0cm x 0.8cm with 80% granulation and 20% slough. Along with standard care, wound was debrided and culture was taken. Skin substitute was deemed necessary due to the wound’s high risk of recurring cellulitis and osteomyelitis due to the proximity to the femur. The following week, wound was noted to be clean and without drainage; DHAM was applied. After one week, wound measured 0.7cm x 0.8cm x 0.1cm. Again, wound underwent standard care and debridement. Results of the culture taken two weeks prior were positive for moderate growth of MRSA; prescription antibiotics were ordered and infection was later resolved. A second and final DHAM was applied at this visit. Within the next week, the wound was noted to be fully closed.

Results: After failing six weeks of standard care, two applications of DHAM in conjunction with serial debridement and standard care enabled full wound closure within one month.

Discussion: Despite standard care, the heightened risk of cellulitis and osteomyelitis necessitated expedited wound healing. This case illustrates clinical efficacy in using DHAM to treat nonhealing, cellulitis-induced ulcer in a geriatric, wheelchair-bound male with ataxia and traumatic brain injury. More extensive studies should investigate DHAM efficacy in healing cellulitis-induced ulcers.