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Case Series/Study
Our first patient is a 67-year-old male with a history of diabetes, lymphedema, PVD, and cardiovascular disease. His recalcitrant ulcer began with a puncture injury of his heel several years ago. Attempted treatments include negative pressure therapy, placental grafts, and split thickness skin grafting, at one point with calcaneus exposed. At time of CAT injection patient had a Wagner II ulceration measuring 0.2 x 0.2 x 0.1 cm.
Our second patient is an 80-year-old male with history of venous insufficiency, malnutrition, and anemia. Over 19 months of recalcitrant ulceration, he underwent serial in-office debridement’s with waxing and waning of the ulcer measurements. Prior to the most recent intervention, the Wagner II ulceration measured 0.8 x 0.3 x 0.3 cm.
In the operating room 3 mL of CAT was subcutaneously implanted via an injection circumferentially. Patients were instructed to be non-weight bearing for 4 weeks. Re-ulceration is a primary endpoint of the study.
Results: The CAT was present at the sites of implantation in both patients at 1 and 3 weeks postoperative at the time of writing. There were no re-ulcerations with significant reduction of peri-wound callus formation. There were no CAT-related complication. Long-term follow-up is ongoing.
Discussion: CAT is an allograft which retains the structure of native tissue that provides cushioning and structural support. It is designed to be used for supplemental support and reinforcement in underlying adipose tissue defects or damage; as such, CAT may be a valuable tool in the management of recalcitrant FUs. CAT has to this point maintained structural support at the sites of implantation. Additional follow-up will be required to further evaluate CAT durability.