Case study 1. A 68-year-old male presented with a 2-year history of chronic venous ulcers located at the medial aspect of his right leg, resulting from chronic venous hypertension (Figure 1A). He was referred to the authors’ wound clinic by the vascular surgery department after failed standard therapy with compression therapy and absorptive dressings for 2 years.
Punch biopsies of the wound bed ruled out malignancy. He was then started on weekly ECM applications with compression therapy (PROFORE Multilayer Compression Bandage System, Smith & Nephew, St. Petersburg, FL). A total of 12 applications were approved and applied. The ECM product was applied weekly unless remnants of the product were seen adhering to the wound bed, then the application was delayed until the next week. Figures 1B-1E show the progression of the wound after 12 applications of the ECM, where 95% healing was achieved in 4 months. Figures 1B and 1C show the caramelization seen in the wound bed, which represented the remnants of the ECM product.
Case study 2. A 77-year-old-female presented with a nonhealing wound to her left Achilles tendon that had lasted for 1 year. The wound bed was covered with thick slough (Figure 2A). The patient was receiving daily prednisone for a platelets disorder and also had vasculitis. The patient was taken to the operating room and underwent surgical debridement of her wound followed by the ECM application to promote granulation at the wound bed (Figure 2B). Surgical pathology and cultures were performed. The pathology didn’t show any malignancy and the soft tissue culture grew Staphylococcus aureus sensitive to doxycycline. Figure 2C shows the ECM covering the left Achilles tendon ulcer 2 weeks after application. One week later, the patient returned to the operating room and received a split-thickness skin graft for a permanent coverage of her wound. Figure 2D shows the skin graft covering the wound 2 weeks after the procedure.
Case study 3. A 78-year-old male presented with a chronic venous ulcer wound on his right leg of 2 years duration. The patient had a chronic unstable scar from cast application 15 years prior. The wound bed was covered with friable granulation tissue and slough (Figure 3A). Surgical debridement was performed and the pathology revealed Marjolin’s ulcer, a squamous cell carcinoma. The patient was returned to the operating room for a surgical excision of the carcinoma with frozen section to clear the margins (Figure 3B). One week later, the ECM product was applied in the outpatient setting along with compression therapy. Figure 3C shows the wound 1 week after application. The following week, a second application was performed in the wound center. Figure 3D shows the wound 4 weeks after the second application. Six weeks after the second application, the ulcer was completely healed (Figure 3E).
Case study 4. The patient is a 66-year-old female with a history of chronic respiratory failure, and she took coumadin for atrial fibrillation. She was admitted to Sycamore Medical Center, Miamisburg, OH, after sustaining trauma to her right hand, resulting in a large hematoma (Figure 4A). After administration of coumadin was stopped for 5 days, the patient was taken to the operating room and underwent surgical debridement of the hematoma, which left partially exposed extensor tendons (Figure 4B). Figure 4C shows an intraoperative view of the ECM covering the wound. Figure 4D demonstrates the wound 2 weeks postapplication. Only 1 application was required to achieve complete healing in 4 weeks (Figure 4E).
Case study 5. An 82-year-old male was admitted to Sycamore Medical Center, Miamisburg, OH, with idiopathic peripheral neuropathy and a 3-month-old stage IV sacral coccygeal pressure wound that was previously debrided and osteomyelitis was ruled out with a bone biopsy (Figure 5A). After his discharge, he followed up at the wound center and the ECM and negative pressure wound therapy (NPWT) were applied. Negative pressure wound therapy was applied over the ECM in this case as a bolster dressing to protect it. The ECM was applied weekly and NPWT was changed twice a week. A nonadherent adaptic layer was placed between the ECM and NPWT. Figure 5B shows the wound 1 week after the first application of the ECM. Off-loading using appropriate cushion and air mattress was continued at the patient’s home, along with nutrition support with the use of protein supplements. Figure 5C shows the pressure ulcer 3 weeks later and after 4 applications of the ECM. After 3 months and 11 applications of the ECM, the patient’s wound had completely healed (Figure 5D).
Case study 6. A 63-year-old male patient with diabetes status post transmetatarsal amputation (TMA) of gangrenous left forefoot with flaps closure presented to the authors’ wound center for follow-up after amputation. The surgery was complicated with postoperative dehiscence requiring debridement. A total of 3 ECM applications were required over a 2-month period. Figures 6A and 6B show intraoperative views of wound debridement with the first ECM application, medial, and frontal views, respectively. Figures 6C and 6D show the ECM’s third application, medial, and frontal views, respectively, in an outpatient setting. Figures 6E and 6F show nearly healed TMA wounds at 2 months and after 3 applications of the ECM.