Abstract
Sacral decubitus ulcers—commonly referred to as pressure ulcers—affect thousands of patients each year. Standard care can be costly and may require long-term management. Grade II sores risk progressing to stages III and IV without timely intervention, and late-stage ulcers often involve complex defects that may extend to tendon or bone, as seen in the two cases reviewed in this study.
Case Overview
The first patient presented with a mid-sacral ulcer involving exposed tendon, bone, and tunneling persisting for ten years. The second patient had an ischial ulcer of more than 30 months’ duration, also with tendon and bone involvement. Both individuals had undergone extensive conservative care including debridements, antibiotics, wound vac management, topical dressings, and prior allograft applications without adequate resolution.
After continued lack of improvement, each patient received multiple applications of Wharton’s Jelly (WJ), a mesenchymal connective tissue (MCT) allograft, alongside ongoing standard wound care such as debridement, antibiotics, and electrical stimulation.
Results
At evaluation with Dr. Michael Lavor, both patients were diagnosed with stage IV pressure ulcers involving bone and tendon based on NPUAP classification. After eight months of continued wound care and six WJ allograft applications, both cases demonstrated over 90% wound contraction in depth, tunneling, and diameter.
Conclusion
This two-patient case review suggests that Wharton’s Jelly allografts, when used alongside standard care, may support tissue supplementation in late-stage sacral decubitus ulcers with deep tunneling. Further research is warranted to evaluate application techniques, procedural timing, and frequency within broader clinical populations.