Disclosures: Neha A. Shah, DO: Nothing to disclose

Case Description: 52-year-old male with history of DM II and bilateral Charcot arthropathy with 2-cm ulceration on the plantar aspect of his left foot. He underwent reconstruction of his left foot on 10/19/2018, with placement of an external fixator and K-wire. Ulcer was debrided and fit with a wound vac. He was determined to be a good candidate for graft placement.

Setting: Hines VA Acute Inpatient Rehabilitation Hospital

Patient: 52-year-old male

Assessment/Results: EpiFix fenestrated mesh graft on left plantar mid-foot ulceration was placed. He attended weekly follow-up appointments in the graft clinic. The wound base remained hypergranular and consistently reduced in diameter. On 1/23/2019, the ulceration site was fully epithelialized. On 2/4/2019, external fixator was removed and a short leg cast was placed. No further ulcer related follow up was required.

Discussion: This patient’s treatment course illustrates the ideal outcome for a patient with a diabetic foot ulcer in the setting of Charcot foot surgery, treated with an amniotic tissue graft. The wound reached full closure after 11 weeks of treatment with the EpiFix graft. In previous studies, the average healing time for patients with diabetic foot ulcers treated with amniotic tissue graft was 2.4 weeks. However, previous literature did not include post-surgical and Charcot foot cases. The previous standard of care for patients with diabetic foot ulcers included wound debridement, topical antibiotics, and dressing changes until healing was observed. With this new therapy, patients are instructed not to remove dressings and follow up for EpiFix placement by the physician at regular intervals. This decreased need for patient compliance and involvement in their wound dressing changes may contribute to the increased effectiveness and reduced healing times.

Conclusion: When compared to standard of care, the application of human amniotic membrane has showed promise in treating indolent wounds, even in post-surgical patients, with underlying Charcot foot.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-role-of-amniotic-membrane-in-a-patient-with-diabetic-foot-ulcer-after-charcot-foot-surgery-a-case-report/