Chronic Venous Insufficiency (CVI) is a lifelong, moribund, and debilitating disease process with tremendous personal and financial costs. At its core, CVI involves blood pooling in the lower extremities secondary to inadequate venous blood return, resulting in venous hypertension and incompetence of the one-way valves in the lower extremity veins. As venous circulation slows, metabolic demands of the cells in the lower extremities increase, leading to stasis dermatitis, infection, cellular death, and venous ulceration. This case study aims to report the efficacy of Dehydrated Amniotic Membrane Allograft (DAMA) applications to a chronic right lateral ankle ulcer resulting from chronic venous insufficiency.
The patient in this study received DAMA applications weekly for six weeks. Upon examination at the initial application, the wound was wet and macerated due to drainage with significant hemosiderosis and lipodermatosclerosis consistent with a Venous Clinical Severity Score (VCSS) of 2. Upon inspection at the final visit, the wound was closed, with a VCSS of 0. This case study demonstrates that the application of DAMA has the potential to act as an effective barrier to cover and accelerate wound closure time. Future non-randomized and randomized controlled trials may further establish standardized protocols for DAMA application in venous ulceration, help create treatment algorithms to predict wound closure endpoints, and encourage innovation that may further accelerate healing time.
Chronic venous insuffi ciency is a common and overlooked health issue that aff ects more than 25 million adults in the US . It is estimated that up to 40% of the US population suff ers from CVI . CVI is the cause of 80% of lower leg ulcer cases worldwide . Recent studies have approximated that the annual cost of healthcare for CVI is $3 billion . These treatment costs range from $15 to $509,275 and include interventions from over-the-counter Tegaderm dressings to below-the-knee amputations. When travel expenses to doctor appointments, physical or occupational therapy appointments, and durable medical equipment evaluations are considered, the cost only rises . CVI is responsible for up to 70% of all lower extremity venous ulcerations. Chronic venous ulcers, particularly in diabetic patients with CVI, warrant immediate and aggressive treatment as they precede 85% of lower extremity amputations .