Sometimes patience pays off: When amputation is the alternative

Abstract

Extended lower extremities defects due to systemic diseases can lead to amputation. This study aims to illustrate the successful treatment of two patients with chronic and therapy-resistant soft tissue defects of the lower leg, which healed with the use of gamma-irradiated human skin allograft (Gammagraft™, Promethean LifeSciences Inc, Pittsbourgh, PA/USA) and artificial dermis (Integra™, Integra LifeSciences Corporation, Plainsboro, NJ/USA) respectively. Both patients presented at admission with extended lower leg necrotic ulcers and both had a positive history of vasculopathy. The patient A was a 42 years old, male, with Scleromyxedema (SM) and the patient B was a 52 years old, female, diabetic and thrombophilic, which also suffered from Systemic Lupus Erythematosus (SLE). Serial wound debridements, amputation of single toes and skin grafting, were paired with modern reconstructive tools, like hydrosurgery system (Versajet◊, Smith & Nephew, London/UK), Vacuum Assisted Closure system (VAC®, KCI, San Antonio, Tx/USA) and tissue engineered products: Gammagraft™ on patient A and Integra™ on patient B. The follow up revealed a long-term durable coverage of the defects. While there is no evidence to support a gold standard for extended chronic lower extremities defects of such origin, whose other alternative seems to be amputation, we believe that patience combined with the use of different reconstructive methods can add another valuable tool in our armamentarium and should considered as a valid reconstructive option.