NEOX Cryopreserved Umbilical Cord in Acute Orthopedic Trauma Wounds: A Case SeriesKAITLYN GRIFFIN, BS; CHRISTOPHER STEWART, MD
ORTHO ARKANSAS, BAPTIST MEDICAL CENTER, LITTLE ROCK, ARPOSTER PRESENTATION AT SAWC SPRING 2017, SAN DIEGO, CA
IntroductionThe umbilical cord possesses unique anti-inflammatory and anti-scarring properties.1-3 These properties have led to the use of the product in cryopreserved graft form (NEOX CORD 1K) as an advanced therapy to promote rapid and complete healing in challenging wound environments. To date, however, its use for acute wound management related to traumatic injuries has not been published. In open fractures the infection rate has been shown to range from 20.8-24.7%.4 This series was reviewed to determine whether the use of NEOX CORD 1K would decrease infection rates, allow for early and definitive soft tissue coverage and decrease reoperation rates.
MethodsHere, the authors present thirty-three (33) consecutive orthopedic trauma wounds treated with NEOX CORD 1K as an adjunctive wound therapy. The types of wounds are shown in Table 1. Of the 33 patients treated, two were lost to follow-up and one patient died. Of the remaining 30 patients, the average age and BMI were 47.5 (range 21-75) and 28.1 respectively. Comorbidities are shown on Table 2. With the addition of the NEOX CORD 1K application, all patients received standard wound care protocols.
Wound/Injury Type #of PatientsTreated
Closedcalcanealfracture 6
Fractures withacuteosteomyelitisandtissueloss
5
GradeIIIBopenfracture 4
Softtissuewound 3
ClosedPilonfracture 2
GradeIIICopen fracture 2
Closedanklefracture 2
Non-union 2
Chronicwound 2
Charcotarthropathy withosteomyelitisincludingsofttissueloss
1
Diabeticfootulcerwithosteomyelitis
1
Comorbidity # ofPatientsTreated
Osteomyelitis 66%
Nicotinedependence
43$
PeripheralVascularDisease
40%
Alcohol/DrugDependence
37%
Diabetes 17%
CongestiveHeartFailure
10%
TABLE 1 TABLE 2
NEOX Cryopreserved Umbilical Cord in Acute Orthopedic Trauma Wounds: A Case Series
ResultsOn average, patients received 1.1 applications of NEOX CORD 1K to achieve wound closure/healing. Only 2 patients required reoperation for wound complications (7%). Only three patients required reoperation for infection (10%). A plastic surgeon was not required for closure of any of the wounds treated.
The use of NEOX CORD 1K as a tissue substitute allowed for early coverage and/or wound stabilization in a challenging set of patients that often require reconstructive intervention by a plastic surgeon. Furthermore, the use of NEOX CORD 1K decreased wound complications leading to a low reoperation/readmission rate in complicated closed/open fractures in a diverse patient population. These findings are significant for both patient outcomes and hospital cost containment.
CONCLUSION
3.5 Weeks Post Injury 1 Month 2 Months
4.5 Weeks 5.5 Weeks 9 Weeks
Clinical HistoryA 38-A 66-year-old white male presented in the ER with R Grade IIIC open tibia/fibular fractures after a automobile collision. He smoked 1.5 packs of cigarettes daily and used methamphetamines. Among the treatments he received during 11 days of hospitalization were: open reduction of internal tibia and fibular fractures, posterior tibial artery graft, lateral fasciotomy closure and a skin graft (27 x 9 cm).On day 11 he was discharged to rehab with dressing changes.
ProcedureAt 3.5 weeks post injury he presented with a large open wound. At one month post injury, the wound was irrigated and debrided and two pieces of NEOX CORD 1k (6x3 cm and 8 x 3cm) were used. At 2 months post injury, the leg was irrigated and debrided and another 8x 3cm NEOX CORD 1K graft was placed on the wound.
TechnologyThe umbilical cord possesses unique regenerative, anti-inflammatory and anti-scarring properties.1-3 These properties have led to the use of product in cryopreserved graft form (NEOX CORD 1K) as an advanced therapy to promote rapid and complete healing in a challenging wound environment.
Case Study Example: Open Wound After Tibial/Fibular Fractures
ResultsAs the wound healed over the following months there is a noticeable difference between the area of the leg with the skin graft and that with the NEOX CORD 1K grafts, with the latter showing less scarring and more tissue regeneration.
Area with Skin Graft
Area treated with NEOX CORD 1K
EDU-CS-38 Rev A
1. He et al., (2009) J Biol Chem, 284:20136-46; 2. Zhang et al., (2012) J Biol Chem, 287: 12433-44; 3.He et al., (2013) J. Biol Chem, 288: 25792-803
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