PMC7233887_01
Chronic painful vasculitic wound due to polyarteritis nodosa. (a) Painful wound on the left leg measured 6.7 x 4.5 x 0.1 cm3 at initial presentation and was treated with negative pressure wound therapy (NPWT) and dressing changes. (b) At week 2, there was lack of epithelialization and pain was still severe (8-9/10), so umbilical cord (UC) allograft was applied. Pain resolved overnight (0/10), and the patient discontinued opioid use. NPWT was discontinued at week 3. (c) At week 4, a second UC graft was placed. (d) By week 11, progressive wound healing was evident along with remnant UC graft. (e) At week 12, an injection of 25 mg of AM/UC particulate was administered. (f) Complete wound closure with return of pigmentation was evident by week 19, following a second AM/UC particulate injection 2 weeks prior.
10.1177_2050313X20910599-fig1.jpg
PMC7233887_01_10.1177_2050313X20910599-fig1.jpg
fig1-2050313X20910599
The patient presented to the wound clinic with a chronic (>3.5 months) painful wound over the anterior tibia measuring 6.7 x 4.5 x 0.1 cm3 on the left leg (Figure 1(a)). Within the first 14 days, the wound had formed extreme exudate (Figure 1(b)), and the patient still suffered from severe pain, reporting an 8-9 out of 10 on the Numeric Rating Scale (NRS). At 4 weeks (Figure 1(c)), another UC allograft was placed on the wound. Over the next 7 weeks (Figure 1(d)), the wound was covered by granulation tissue along with allograft remnant. At 12 weeks (Figure 1(e)), the wound measured 4.0 x 2.0 x 0.1 cm3, and an injection of 25 mg of AM/UC particulate (NEOX FLO; Amniox Medical, Miami, FL) in 2 mL preservative-free saline was given (Figure 2), which resulted in reduction of the wound size and depth. At week 17, another AM/UC injection was administered, which ultimately resulted in complete wound healing 2 weeks later (Figure 1(f)).
Representative example of AM/UC application. AM/UC particulate was reconstituted in preservative-free saline and injected around the wound parameter.
10.1177_2050313X20910599-fig2.jpg
PMC7233887_01_10.1177_2050313X20910599-fig2.jpg
fig2-2050313X20910599
AM/UC particulate (NEOX FLO; Amniox Medical, Miami, FL) in 2 mL preservative-free saline was given (Figure 2), which resulted in reduction of the wound size and depth. At week 17, another AM/UC injection was administered, which ultimately resulted in complete wound healing 2 weeks later (Figure 1(f)).
PMC7233887_02
Chronic painful wound healing associated with PAD. (a) Umbilical cord allograft was applied to the wound at week 2. Progressive wound healing was seen thereafter at (b) week 3, (c) week 5, and (d) week 7.
10.1177_2050313X20910599-fig3.jpg
PMC7233887_02_10.1177_2050313X20910599-fig3.jpg
fig3-2050313X20910599
At 2 weeks, the wound slightly decreased to 2.8 x 1.4 x 0.3 cm (Figure 3(a)), and a 3 x 2 cm2 UC allograft (NEOX CORD) was placed over the wound with non-adherent silicone dressing (Adaptic). One week later (Figure 3(b)), the allograft remained over the wound bed, and the patient reported no wound pain (score of 0/10 on the NRS). Intense granulation tissue was seen by week 5 (Figure 3(c)), followed by closure of the wound by week 7 (Figure 3(d)).
PMC7233887_03
Chronic painful arterial wound. (a) Initial wound was treated with honey gel and antimicrobial foam dressing. Wound showing healing at (b) week 2 and (c) week 3. (c) Umbilical cord allograft was applied at week 4, and wound pain resolved 3 days later. (d) Complete wound closure was seen at week 6.
10.1177_2050313X20910599-fig4.jpg
PMC7233887_03_10.1177_2050313X20910599-fig4.jpg
fig4-2050313X20910599
A wound (1.0 x 1.2 x 0.1 cm3) was located on the proximal part of the right leg and diagnosed as an arterial ulcer (Figure 4(a)). Ag antimicrobial foam dressing were applied and changed weekly. The wound demonstrated healing at week 2 (Figure 4(b)) and week 3 (Figure 4(c)). At week 4, a 2 x 2 cm2 UC allograft (NEOX CORD 1K) was applied. Complete wound closure was achieved at week 6 (Figure 4(d)).