Innovative treatment of diabetic ulcers: combining chemical debridement and xenograft applications: a case study.

Lower extremity diabetic ulcers (LEDUs) are a common, high-morbidity complication of diabetes, frequently leading to infections, hospitalisations and emergency department visits. This case study examines the treatment effectiveness of a novel wound care approach in a 57-year-old female patient with a hard-to-heal LEDU (a diabetic foot ulcer of the left lower extremity) complicated by poorly controlled diabetes (glycated haemoglobin A1c: 13%). Initially, standard of care (SoC) practices, including alginate dressings, hypochlorous acid gel and sharp debridement, were ineffective in promoting significant healing.

Dehydrated human amnion/chorion membrane to treat venous leg ulcers: a cost-effectiveness analysis.

Objective: To evaluate the cost-effectiveness of dehydrated human amnion/chorion membrane (DHACM) in Medicare enrolees who developed a venous leg ulcer (VLU).

Method: This economic evaluation used a four-state Markov model to simulate the disease progression of VLUs for patients receiving advanced treatment (AT) with DHACM or no advanced treatment (NAT) over a three-year time horizon from a US Medicare perspective. DHACM treatments were assessed when following parameters for use (FPFU), whereby applications were initiated 30-45 days after the initial VLU diagnosis claim, and reapplications occurred on a weekly to biweekly basis until completion of the treatment episode.

Navigating obstacles impacting the sustainability of Medicare-funded wound care pricing.

With more effective oversight, Medicare costs can be reduced, while stabilising a portion of its trust fund, disincentivising non-compliance and improving outcomes for the growing population of US beneficiaries with hard-to-heal wounds.

Treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers.

Objective: To retrospectively evaluate the comorbidities, treatment patterns and outcomes of Medicare enrolees who developed venous leg ulcers (VLUs).

Method: Medicare Limited Data Standard Analytic Hospital Inpatient and Outpatient Department Files were used to follow patients who received medical care for a VLU between 1 October 2015 and 2 October 2019. Patients diagnosed with chronic venous insufficiency (CVI) and a VLU were propensity matched into four groups based on their treatment regimen.

Deep palm burn treated with enzymatic debridement followed by autologous skin cell suspension: a case study.

Despite improvements in treatment methods and outcomes, burns remain one of the principal causes of mortality and morbidity worldwide. Burns involving the hands are estimated to occur in >80% of people with burns. Hand burns have also been associated with long-term social, psychological and physical consequences that can impede a patient's full reintegration to the community and decrease their overall quality of life.

Dehydrated human amnion/chorion membrane use in emergent craniectomies shows minimal dural adhesions.

Decompressive craniectomies (DCs) are routinely performed neurosurgical procedures to emergently treat increased intracranial pressure secondary to multiple aetiologies, such as subdural haematoma, epidural haematoma, or malignant oedema in the setting of acute infarction. The DC procedure typically induces epidural fibrosis post-cranial resection, resulting in adherence of the dura to both the brain internally and skin flap externally. This becomes especially problematic in the setting of skull flap replacement for cranioplasty as adherences can lead to bridging vein tear, damage to the underlying brain cortex, and other postoperative complications.

Best practice for wound repair and regeneration use of cellular, acellular and matrix-like products (CAMPs).

There are currently over 80 biomaterials derived from autologous, allogeneic, synthetic and xenogeneic sources, or a combination of any or all these types of materials, available for soft-tissue coverage to effect wound closure. Often generically referred to as cellular and/or tissue-based products (CTPs), they are manufactured under various trade names and marketed for a variety of indications.

Specialty specific quality measures needed to improve outcomes in wound care.

Despite the health care community's best efforts, 20% of diabetic patients who develop a diabetic foot ulcer will require some form of amputation. Those undergoing a major lower extremity amputation risk an increase in their five-year mortality rate to 56.6%, which is comparable to or higher than many forms of cancer.

Expandable dehydrated human umbilical cord allograft for the management of nonhealing lower extremity wounds in patients with diabetes: a case series.

Advanced wound treatments are derived primarily from human placental membranes or animal tissue sources and composed of cellular and acellular dermal substitutes. The use of advanced wound treatments is practitioner directed and individualized to the wound characteristics. A multidisciplinary approach to wound closure is necessary, including the use of advanced treatments (eg, human umbilical cord derivatives) to achieve durable resolution of hard-to-heal wounds.

Pyoderma gangrenosum and dehydrated human amnion/chorion membrane: a potential tool for an orphan disease.

Objective: Pyoderma gangrenosum (PG) is an often-misdiagnosed, painful, inflammatory and ulcerative skin disorder. It is an orphan disease, where standard wound treatments such as sharp surgical debridement are contraindicated. This retrospective case series sought to evaluate the application of dehydrated human amnion/chorion membrane (DHACM) as a skin substitute in cases that were refractory to a range of standard-of-care techniques.

The influence of adequate debridement and placental-derived allografts on diabetic foot ulcers.

Objective: To determine the role of debridement when patients are using placental-derived allografts (PDAs), data from two prospective, multicentre, randomised controlled trials (RCTs) were evaluated for the quality or adequacy of debridement on diabetic foot ulcers (DFUs) treated with PDAs. Results were compared with real-world findings via a retrospective analysis of 2015-2019 Medicare claims for DFUs.

Method: Debridement adequacy in the prospective RCTs was adjudicated by three blinded wound care specialists.

Cost-effectiveness of dehydrated human amnion/chorion membrane allografts in lower extremity diabetic ulcer treatment.

Objective: To evaluate the cost-effectiveness and budget impact of using standard care (no advanced treatment, NAT) compared with an advanced treatment (AT), dehydrated human amnion/chorion membrane (DHACM), when following parameters for use (FPFU) in treating lower extremity diabetic ulcers (LEDUs).

Method: We analysed a retrospective cohort of Medicare patients (2015-2019) to generate four propensity-matched cohorts of LEDU episodes. Outcomes for DHACM and NAT, such as amputations, and healthcare utilisation were tracked from claims codes, analysed and used to build a hybrid economic model, combining a one-year decision tree and a four-year Markov model.