OP035 INFLUENCE OF ADEQUATE DEBRIDEMENT & PLACENTAL-DERIVED ALLOGRAFTS IN THE MANAGEMENT LOWER EXTREMITY DIABETIC ULCERS.

Aim: Evaluate the impact of the frequency of debridement along with the concurrent use of a skin substitute in the management of chronic lower extremity diabetic ulcers (LEDUs). Method: Debridement adequacy in the prospective RCTs was adjudicated by three wound care specialists (Figure 1). Treatments included two placental-derived allografts compared with standard of care (SOC). Additionally, a retrospective analysis of 2015-- 2019 Medicare claims for LEDUs that received routine debridement at intervals ranging from every 1--7 days, 8--14 days, and every 15 days or greater was performed. Examples of inadequate debridement: significant callous and epibole present (a) and adequate debridement: evidence of pairing of callous and removal of epibole (b). Results: Within the RCTs, adequate debridement occurred in 202/265 (76%) of patients, 90/110 (82%) SOC ulcers, 45/54 (83%) of DHACM* treated ulcers, and in 67/101 (66%) of DHUC† treated ulcers. Closure occurred in 74% of adequately debrided ulcers, and in only 21% of ulcers without adequate debridement, p<0.0001. Debridement was the most significant factor for closure even when controlling for other clinical characteristics (Table 1). Within the Medicare claims data 21% of episodes treated with SOC only had debridement intervals of ≤7 days. Short debridement intervals in combination with the use of DHACM demonstrated statistically better outcomes than SOC including 65% fewer major amputations (p<0.0001). Conclusion: Prospectively collected data examining the quality of debridement and retrospectively analyzed data examining the frequency of debridement supports routine adequate debridement, particularly at intervals of seven days, as an essential component of wound care. *DHACM=Dehydrated Human Amnion Chorion Membrane †DHUC=Dehydrated Human Umbilical Cord [ABSTRACT FROM AUTHOR]