(CS-065) Limb Salvage in a High-Risk Dialysis Patient: Healing a Trimalleolar Fracture with Chronic Wounds Using Borate-Based Bioactive Glass Fiber Matrix After Debridement and Arthrodesis External Fixation

Introduction: Limb salvage in patients with end-stage renal disease (ESRD), immunosuppression, and chronic wounds presents a
significant clinical challenge due to impaired perfusion, delayed healing, and elevated infection risk.2
These factors often lead to major amputation when orthopedic trauma or multisite wounds are present. Creating an optimal wound
environment after surgical debridement is critical to promote angiogenesis, tissue regeneration, and durable healing.
Borate-based bioactive glass fiber matrices (BBGFM) have emerged as an adjunct to proper wound care practices to
support secondary intention healing. This case highlights BBGFM’s use in a multimodal limb salvage strategy for a
dialysis-dependent transplant patient with a complex ankle fracture and chronic lower extremity wounds.

Methods: A 70-year-old male with ESRD on dialysis and prior liver transplant presented with a chronic medial venous leg ulcer (VLU).
In December 2024, he sustained a trimalleolar ankle fracture complicated by fracture blisters and anterior foot eschar from
dressing pressure, a complication from the VLU treatment. Vascular assessment showed non-palpable posterior tibial pulses
with Doppler-detected dorsalis pedis signal. On Jan 10, 2025, he underwent left ankle arthrodesis with external fixation.
Adjunctive wound care included:
• 02/26/2025: Initial surgical debridement and BBGFM application to large defect wounds
• 03/19/2025: Subsequent debridement and BBGFM reapplication
• 04/14/2025: External fixator removal, debridement, BBGFM reapplication, and NPWT initiation
Wound progression was monitored through clinical observation and photographic documentation with measurements.

Results: Over a three-month treatment period and following four applications of BBGFM, demonstrated substantial
percentage area reduction, progressing to full closure. The matrix adapted well to complex wound topography, supporting
robust granulation and enhanced wound bed vascularity. After removal of the external fixator and initiation of BBGFMsupported NPWT, the wounds remained stable with continued epithelialization and no signs of infection. This multimodal
strategy resulted in complete wound resolution and successful limb salvage without further surgical intervention.

Discussion: This case demonstrates the effective use of BBGFM as an adjunct in a successful limb salvage strategy for a high-risk patient
with ESRD, transplant history, and complex lower extremity wounds. The BBGFM supported granulation, vascularization, and
wound healing. The extracellular matrix like material provides an optimal environment to support new blood vessel formation
and encourages native cell migration, resulting in a well vascularized and organized wound bed. This case underscores the
BBGFM’s role in limb salvage protocols where chronic wound healing is impaired. Further investigation is warranted to define
its efficacy in similarly high-acuity patients.