(CS-145) Chronic Wounds Healed with the use of Dehydrated Human Amnion Chorion Membrane (DHACM*) in Long-Term Care Settings

Chronic wound rates continue to increase. Among Medicare beneficiaries, this increased from 14.5% in 2014 to 16.3% in 2019.¹After four weeks of the standard of care (SOC), with less than 50% surface area reduction, wounds are considered chronic^2-4 and have been shown to benefit from Dehydrated Human Amnion Chorion Membrane* (DHACM)^5-7 applications. The Diabetes Guidelines recommend that Advanced Therapies, such as DHACM, are considered for these chronic wounds.⁸ Increasingly, polymorbid patients who require polypharmacy have chronic wounds and are treated in long-term care (LTC) facilities. The evidence is strong regarding the relationship between the number of comorbidities and risks for poor outcomes.⁹ These providers seek evidence-based treatments for chronic wound closure in their complex polymorbid patients.

In this case series, we describe four cases of complex patients in LTC setting for chronic wound treatment, and weekly DHACM allografts were added to their therapy regimen. These patients encompassed four wound types: diabetic foot ulcer, venous leg ulcer, surgical dehiscence, and a traumatic wound.

Methods:

A series of four patients with four unique chronic wound types who failed three or more months of SOC were then treated with weekly DHACM applications. All of the patients are polymorbid and have subsequent ongoing polypharmacy treatment.

SOC included weekly sharp curette/scalpel debridement for all four wounds. Specific to the wound type and needs of the individual patient, Thera honey^¶, collagen sheet^‡ and collagen powder^‡, Ca alginate sheets^º, Bactroban 2% ointment, xeroform^, wet-to-dry dressings, compression therapy, offloading, and or negative pressure wound therapy were used. Due to a lack of wound-closing progress after a three-month or greater period, weekly DHACM allografts were added to the care regime.

Results: Four complex patients with five chronic non-progressing wounds were treated with DHACM. Two wounds are closed at the time of abstract submission, and the other three decrease weekly. We look forward to updating the results if selected to present at SAWC Spring 2024.

Discussion:

Novel uses of DHACM showed success in the long-term care setting on various wound etiologies in polymorbid and polypharmacy patients. Of note, the patient has 30 or more diagnoses in most cases. At the time of submission, two of the four wounds were closed. The remaining two wounds have decreased in size and are expected to close in weeks. We anticipate treating wounds without a 50% reduction after four weeks of SOC at this LTC.