Tissue augmentation with allograft adipose matrix for the diabetic foot in remission

Tala B. Shahin, Kairavi V. Vaishnav, Marcy Watchman, Vignesh Subbian, Ethan Erik Larson, Evangelia Chnari, David G Armstrong

Research output: Contribution to journalArticle

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Abstract

Background: Repetitive stress on the neuropathic plantar foot is the primary cause of diabetic foot ulcers. After healing, recurrence is common. Modulating plantar pressure has been associated with extension of ulcer free days. Therefore, the goal of this study was to determine the effects of an injectable allograft adipose matrix in providing a protective padding and reducing the pressure in the plantar foot. Methods: After healing his recurrent ulcer using total contact casting, a 71-year-old man with a 9-year history of recurrent diabetic foot ulcers was treated with injection of allograft adipose matrix, procured from donated human tissue. This was delivered under postulcerative callus on the weight-bearing surface of the distal end of the first ray resection. As is standard in our clinic for tissue augmentation procedures, our patient underwent serial plantar pressure mapping using an inshoe pressure monitoring system. Results: There was a 76.8% decrease in the mean peak pressure due to the fat matrix injected into the second metatarsal region and a 70.1% decrease in mean peak pressure for the first ray resection at the site of the postulcerative callus. By 2 months postoperatively, there was no evidence of residual callus. This extended out to the end of clinical follow-up at 4 months. Conclusion: The results from this preliminary experience suggest that allograft adipose matrix delivered to the high risk diabetic foot may have promise in reducing tissue stress over pre- and postulcerative lesions. This may ultimately assist the clinician in extending ulcer-free days for patients in diabetic foot remission.

Original languageEnglish (US)
Article numbere1555
JournalPlastic and Reconstructive Surgery - Global Open
Volume5
Issue number10
DOIs
StatePublished - Jan 1 2017

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Diabetic Foot
Allografts
Pressure
Bony Callus
Ulcer
Foot
Injections
Metatarsal Bones
Weight-Bearing
Fats
Recurrence

ASJC Scopus subject areas

  • Surgery

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Tissue augmentation with allograft adipose matrix for the diabetic foot in remission. / Shahin, Tala B.; Vaishnav, Kairavi V.; Watchman, Marcy; Subbian, Vignesh; Larson, Ethan Erik; Chnari, Evangelia; Armstrong, David G.

In: Plastic and Reconstructive Surgery - Global Open, Vol. 5, No. 10, e1555, 01.01.2017.

Research output: Contribution to journalArticle

Shahin, Tala B. ; Vaishnav, Kairavi V. ; Watchman, Marcy ; Subbian, Vignesh ; Larson, Ethan Erik ; Chnari, Evangelia ; Armstrong, David G. / Tissue augmentation with allograft adipose matrix for the diabetic foot in remission. In: Plastic and Reconstructive Surgery - Global Open. 2017 ; Vol. 5, No. 10.
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