Safety and efficacy of a dermal substitute in the coverage of cancellous bone after surgical debridement for severe diabetic foot ulceration.

Introduction: Deep Infection of the foot represents a severe complication. After aggressive debridement with residual bone exposition a very proximal mid-foot or rear foot amputation is often the only definitive surgical procedure that permits the foot to be salvaged. Aim: to perform a less severe amputation of the foot by employing a dermal substitute to cover exposed bones. Methods: From September 2006 to February 2008, 23 patients were submitted to aggressive debridement with residual bone exposition (3 TMA, 5 CHOPART amputations, 8 partial calcanectomy, 7 rays amputations). This was followed, after daily dressing to obtain a clean wound, by application of a new dermal substitute constituted by 100% Hyaluronic Acid Benzil Esther (Hyalomatrix PA). Results: We obtained a complete coverage of the exposed cancellous bone in 21 out of 23 patients in a period of 28 ± 17 days of treatment. After a period of 176 ±141 days we observed complete healing of the surgical wounds in 10 out of 23 patients (4 patients treated by skin graft and 6 patients healed by secondary intention). The remaining 11 patients presented reduction of wound area. One patient was submitted to above-the knee amputation due to recurrence of severe foot ischemia while one patient was lost at follow up. Conclusion: Our data demonstrates the safety and efficacy of HyalomatrixPA in coverage of cancellous bone exposition. [ABSTRACT FROM AUTHOR]