Placenta to the Rescue: Limb Salvage Using Dehydrated Human Amnion/Chorion Membrane

Reconstruction of skin and soft tissue wounds can pose a unique surgical challenge. This is especially true for cases of exposed bone and tendon where soft tissue loss is extensive and opportunities for tissue advancement or rotation are limited. A clinical case is presented describing an experience with dehydrated human amnion/chorion membrane (dHACM, EpiFix®/AmnioFix®, MiMedx Group, Marietta, GA) graft to obtain granulation over an open fracture with desiccated bone. The 22-year-old female trauma patient presented with high-grade bilateral lower extremity soft tissue loss after being run over and dragged by a semitruck. Despite several weeks of serial debridemonts, the right distal fibula and left medial femur remained desiccated and infected. Both extremities had cavernous tissue landscapes with minimal granulation tissue and neither was hospitable for split thickness skin grafting. Four separate applications of dHACM (combination of EpiFix® and AmnioFix®) to the affected areas of exposed bone were successful at stimulating a robust granulation bed. On hospital days 44 and 61, the wounds were successfully skin grafted. The authors suspect that the dHACM applications contributed to successful granulation coverage to the affected bones that were otherwise not amendable to other coverage options. This contributed to limb salvage and a successful outcome.