Solutions in Plastic Surgery

Acute Abdominal Wall Dehiscence With EPIFIX⁷

Challenge

62-year-old obese male, BMI of 29, type II diabetes, with a history of hypertension, myocardial infarction with stent placements, multiple abdominal surgeries, and over forty years of cigarette smoking, underwent large ventral hernia repair. At one week post op, the patient developed ischemia at the incision line, which led to an incisional dehiscence.

Studies have shown a direct correlation between the number of comorbidities and clinical outcomes. A significant rise in complications, length of stay, and mortality rates is associated with the rise in number of patient comorbidities.^8-10

Surgical Intervention

The patient was managed with serial debridement and wet-to-dry dressings for two months, then placed on negative pressure wound therapy (NPWT) for four weeks at home. After one month of NPWT, the wound had only decreased by 30%. NPWT was discontinued, and DHACM (Dehydrated Human Amnion/Chorion Membrane) was applied every other week, instead of weekly, due to the travel distance for the patient. The product provides a barrier that supports the healing cascade and protects the wound bed to aid in the development of granulation tissue in acute and chronic closures. It provides a biocompatible human extracellular matrix and contains 300+ regulatory proteins.^2-4

Follow-Up

Upon examination at his two month follow-up visit, the wound was fully closed and re-epithelialized. The patient returned for a routine one-year visit and has remained fully closed and asymptomatic.

Following Debridement

Four weeks of NPWT, only 30% size reduction, first DHACM 4 cm x 4 cm applied

Week 2: Two 2 cm x 3 cm DHACM applied

Week 4: One 2cm x 3 cm DHACM applied

Week 8: Wound closed and stable

Clinical History

Patient presented with keloid after Caesarean section procedure.

Treatment

One third of the keloid scar was treated with DHACM (Dehydrated Human Amnion/Chorion Membrane) in revision surgery to evaluate its outcome prior to treating the remainder of the scar. DHACM was placed within the incision site before suturing.

DHACM provides a barrier that supports the healing cascade and protects the wound bed to aid in the development of granulation tissue in acute and chronic closures. It provides a biocompatible human extracellular matrix and contains 300+ regulatory proteins.^2-4

Follow-Up

The scar was greatly reduced in height and in color. Subsequent revision surgery treated the remainder of the keloid scar with DHACM.

KELOID Scar Revision with DHACM

Post-scar revision using DHACM on 1/3 portion of original scar

Scar one year post DHACM treatment