Download PDF
Phlebologie 2016; 45(02): 93-98
DOI: 10.12687/phleb2305-2-2016
Original article
Schattauer GmbH

Marine Omega3 wound matrix for the treatment of complicated wounds

Experiences associated with amputations in the lower limb in diabetic patientsOmega-3-Wundmatrix zur Behandlung komplizierter WundenErfahrungen nach Amputationen an der unteren Extremität bei Patienten mit Diabetes mellitus
T. T. Trinh
1   Division of Vascular Surgery, Department of Cardiothoracic & Vascular Surgery, University Medical Center Mainz, Germany
,
F. Dünschede
1   Division of Vascular Surgery, Department of Cardiothoracic & Vascular Surgery, University Medical Center Mainz, Germany
,
C.-F. Vahl
1   Division of Vascular Surgery, Department of Cardiothoracic & Vascular Surgery, University Medical Center Mainz, Germany
,
B. Dorweiler
1   Division of Vascular Surgery, Department of Cardiothoracic & Vascular Surgery, University Medical Center Mainz, Germany
› Author AffiliationsWe thank the Institute of Molecular Biology, Sandra Ritz, M.D. at IMB, Mainz for providing assistance with the imaging software Fiji (Image J) for quantification of wound area.
Further Information

Publication History

received: 04 February 2016

accepted: 10 February 2016

Publication Date:
21 December 2017 (online)

Also available at
    Permissions and Reprints

Summary

Introduction Complicated wounds in the lower extremity can arise as a consequence of insufficient soft-tissue coverage after amputations in diabetic patients. The Kerecis® Omega3 wound matrix is a decellularized skin matrix derived from codfish and represents an alternative treatment option to achieve wound healing.

Methods 5 patients with diabetes mellitus and complicated wounds in the lower limb with exposed bony segments were treated with the Omega3 wound matrix between November 2014 and November 2015. Following initial debridement in the operating room, the wound matrix was applied and covered with a silicone mesh. In the further course, wound treatment was conducted on outpatient setting.

Results In total, 7 wounds were treated with localization at the level of the thigh (n=2) and the forefoot (n=5). For the wounds at the thigh, it took 26 weeks to achieve wound closure, whereas the wounds at the level of the forefoot showed healing times between 13 and 41 weeks. In all patients, a reduction of analgetics intake was noted when the treatment with the Omega3 wound matrix was initiated.

Conclusion The Kerecis® Omega3 wound matrix represents a viable treatment option in complicated wounds in the lower limb of diabetic patients to circumvent an otherwise necessary proximalization of amputation level. Further studies comparing the Omega3 wound matrix with appropriate control groups of standard therapies for soft-tissue conditioning/coverage like negative pressure therapy, biosurgery and other acellular dermal matrices are warranted.

Zusammenfassung

Fragestellung Problemwunden nach Amputationen bei Diabetikern können aus insuffizienter Weichteildeckung vergesellschaftet mit freiliegenden Knochenanteilen resultieren. Die Omega3-Wundmatrix (Kerecis®) stellt eine alternative Wundauflage dar, die aus der Haut des Kabeljau durch entsprechende Verfahren wie Dezellularisierung gewonnen wird und seit kurzem in Deutschland verfügbar ist.

Methode Wir berichten über 5 Patienten (1 Frau) mit Problemwunden nach Amputationen, bei denen eine Proximalisierung des Amputationsniveaus drohte. Bei mehreren Patienten war zuvor eine konventionelle Wundbehandlung mit Vakuumtherapie teils über mehrere Wochen ohne durchgreifenden Erfolg durchgeführt worden. Die Erstapplikation der Omega3-Wundmatrix (Kerecis®) nach Debridement und Abdeckung mittels feuchtem Verband erfolgte im OP unter stationären Bedingungen, danach wurden die Patienten einmal wöchentlich ambulant versorgt.

Ergebnisse Insgesamt behandelten wir sieben Problemwunden mit Wundlokalisation am Oberschenkelstumpf (n=2) nach Ober-schenkelamputation bzw. Vorfuß nach Vorfuß- (n=4) bzw. Zehenamputation (n=1). Die Oberschenkelwunden zeigten nach 26 Wochen eine komplette Abheilung. Die Wunden am Vorfuß waren nach 13–41 Wochen verschlossen. Zusätzlich war bei allen Patienten innerhalb der ersten 2 Behandlungswochen mit Kerecis® eine deutliche Verminderung der lokalen Wundschmerzen zu verzeichnen.

Schlussfolgerung Die Behandlung mit dem Omega-3-fettsäurehaltigen Fischhautpräparat (Kerecis®) stellt einen wirksamen Ansatz in der Behandlung von Problemwunden nach Amputationen bei Diabetikern dar. Weitere Untersuchungen sind notwendig, um die Granulations- und Reepithelialisierungsfunktion sowie die zusätzlich vorhandene analgetische bzw. antinozizeptive Wirkung dieses Präparates genauer zu evaluieren.

Keywords

Diabetic ulcer - wound healing - wound matrix - amputation

Schlüsselwörter

Diabetisches Ulkus - Wundheilung - Wundma-trix - Amputation
 

  • References

  • 1 Rüttermann M, Maier-Hasselmann A, Nink-Grebe B, Burckhardt M. Clinical practice guideline: Local treatment of chronic wounds in patients with pe ripheral vascular disease, chronic venous insufficiency and diabetes. Dtsch Arztebl Int 2013; 110 (03) 25-31.
    PubMedSearch in Google Scholar
  • 2 Elraiyah T, Domecq JP, Prutsky G, Tsapas A, Nabhan M, Frykberg RG, Hasan R, Firwana B, Prokop LJ, Murad MH. A systematic review and meta-analysis of débridement methods for chronic diabetic foot ulcers. J Vasc Surg 2016; Feb; 63 (Suppl. 02) 37S-45S.
    PubMedSearch in Google Scholar
  • 3 Ubbink DT, Westerbos SJ, Nelson EA, Vermeulen H. A systematic review of topical negative pressure therapy for acute and chronic wounds. Br J Surg 2008; 95: 685-692.
    CrossrefPubMedSearch in Google Scholar
  • 4 Elraiyah T, Tsapas A, Prutsky G, Domecq JP, Hasan R, Firwana B, Nabhan M, Prokop L, Hingorani A, Claus PL, Steinkraus LW, Murad MH. A systematic review and meta-analysis of adjunctive therapies in diabetic foot ulcers. J Vasc Surg 2016 Feb; 63 (Suppl. 02) 46S-58S.
  • 5 Martin BR, Sangalang M, Wu S, Armstrong DG. Outcomes of allogenic acellular matrix therapy in treatment of diabetic foot wounds: an initial experience. Int Wound J 2005; 02 (02) 161-165.
    CrossrefPubMedSearch in Google Scholar
  • 6 Williams ML, Holewinski JE. Use of a human acellular dermal wound matrix in patients with complex wounds and comorbidities. J Wound Care 2015; 24 (06) 261-262 264-267.
    CrossrefPubMedSearch in Google Scholar
  • 7 Reyzelman A, Crews RT, Moore JC, Moore L, Mukker JS, Offutt S, Tallis A, Turner WB, Vayser D, Winters C, Armstrong DG. Clinical effectiveness of an acellular dermal regenerative tissue matrix compared to standard wound management in healing diabetic foot ulcers: a prospective, randomised, multicentre study. Int Wound J 2009; Jun 06 (03) 196-208.
    CrossrefPubMedSearch in Google Scholar
  • 8 Reyzelman AM. Human acellular dermal wound matrix for treatment of DFU: literature review and analysis. J Wound Care 2015; 24 (03) 128 129-134.
    CrossrefPubMedSearch in Google Scholar
  • 9 Magnusson S, Baldursson BT, Kjartansson H, Thorlacius GE, Axelsson I, Rolfsson O, Petersen PH, Sigurjonsson GF. Decellularized fish skin: characteristics that support tissue repair. Laeknab-ladid 2015; 101 (12) 567-573.
    Search in Google Scholar
  • 10 Zimny S, Schatz H, Pfohl M. Determinants and estimation of healing times in diabetic foot ulcers. J diabetes and its complications 2002; 16: 327-332.
    Search in Google Scholar
  • 11 Baldursson BT, Kjartansson H, Konrádsdóttir F, Gudnason P, Sigurjonsson GF, Lund SH. Healing rate and autoimmune safety of full-thickness wounds treated with fish skin acellular dermal matrix versus porcine small-intestine submucosa: a noninferiority study. Int J Low Extrem Wounds 2015; Mar 14 (01) 37-43.
    CrossrefPubMedSearch in Google Scholar
  • 12 Escudero GE, Romañuk CB, Toledo ME, Olivera ME, Manzo RH, Laino CH. Analgesia enhancement and prevention of tolerance to morphine: beneficial effects of combined therapy with omega-3 fatty acids. J Pharm Pharmacol 2015; 67 (09) 1251-1262.
    CrossrefPubMedSearch in Google Scholar
  • 13 Ko GD, Nowacki NB, Arseneau L, Eitel M, Hum A. Omega-3 fatty acids for neuropathic pain: case series. Clin J Pain 2010; 26 (02) 168-172.
    CrossrefPubMedSearch in Google Scholar