Louisiana Via Research Day Book 2026

Case Studies: Section 1

Case Studies: Section 1

Allison Brown, OMS-III 1 ; Steven Kitchings, MD 2 1 VCOM-Louisiana; 2 Willis-Knighton Hyperbaric and Wound Care Center, Bossier City, Louisiana 57 DERMACELL ACELLULAR DERMAL MATRIX WITH ADJUNCT NEGATIVE PRESSURE WOUND THERAPY FOR LIMB SALVAGE IN A COMPLEX POST-SURGICAL DIABETIC FOOT WOUND

Samantha Valaitis, OMS-IV 1 ; Christopher Oglesby, DO 2 1 VCOM-Louisiana; 2 St. Francis Department of Gastroenterology, Monroe, Louisiana 58 THE RETURN OF THE STONE: CHOLEDOCHOLITHIASIS YEARS AFTER CHOLECYSTECTOMY

Context: Complex post-surgical foot wounds complicated by comorbidities such as diabetes and neuropathy often fail conventional wound care and place patients at high risk for amputation. Advanced biologic therapies, including acellular dermal matrices (ADMs), have shown promise in facilitating granulation and tissue coverage in non-healing wounds. Report of Case: We report the case of a 58-year-old male with type 2 diabetes mellitus who developed a large dorsal foot wound with exposed tendon following surgical incision and drainage. Conventional therapy, including sharp/mechanical debridement, topical agents, and compression, failed to achieve healing. DermACELL (ADM) was applied in multiple sessions with adjunctive negative pressure wound therapy (NPWT). Over 25 weeks, the wound contracted from a starting measurement of 15 cm x 5 cm x 2.7 cm to 4.6 cm x 0.8 cm x 0.1 cm, with complete tendon coverage, robust granulation tissue, and preserved limb function. The patient avoided infection, graft rejection, and amputation, and continues to be followed in the wound care clinic.

Conclusion: This case demonstrates successful limb salvage using DermACELL ADM with adjunct NPWT in a complex post-surgical diabetic foot wound with exposed tendon. Prior studies have reported high rates of granulation and wound area reduction with DermACELL in diabetic foot ulcers; however, literature describing its use in extensive post-surgical dorsal foot wounds remains limited. A focused literature review was conducted using PubMed and Google Scholar with search terms including acellular dermal matrix, DermACELL, diabetic foot wound, negative pressure wound therapy, and limb salvage. Compared with existing reports, this case underscores the effectiveness of staged ADM application combined with NPWT in achieving tendon coverage and sustained wound progression despite multiple healing-impairing comorbidities. Acellular dermal matrices represent a valuable adjunctive therapy in limb-threatening surgical wounds where traditional modalities fail.

Context: Choledocholithiasis years after cholecystectomy is uncommon and may present with nonspecific abdominal symptoms and imaging findings concerning for malignancy or biliary polyps. This case highlights the importance of maintaining suspicion for retained or recurrent common bile duct stones in post cholecystectomy patients. Report of Case: A 70-year-old male presented to the emergency department with one and a half weeks of abdominal pain, nausea, and fever. Past medical history was significant for chronic obstructive pulmonary disease, hypertension, hyperlipidemia, gastroesophageal reflux disease, sleep apnea, restless leg syndrome, and prior cholecystectomy performed eight years earlier. Surgical history also included coronary artery bypass grafting and total knee replacement. The patient was a former cigarette smoker and current smokeless tobacco user, with no alcohol or illicit drug use. Two weeks prior to presentation, he was evaluated in a gastroenterology clinic where computed tomography imaging demonstrated post-cholecystectomy anatomy with dilation of the common bile duct and a soft tissue

nodule within the distal CBD concerning for choledocholithiasis versus polyp or other etiology. On presentation, vital signs revealed low-grade fever (37.9°C). Physical examination was notable for abdominal tenderness with guarding and no rebound. Laboratory evaluation demonstrated elevated bilirubin levels consistent with biliary obstruction. Given concern for obstructive pathology and possible infection, empiric piperacillin-tazobactam was initiated and gastroenterology was consulted. The patient underwent endoscopic retrograde cholangiopancreatography with sphincterotomy, which revealed a 19-mm common bile duct stone that was successfully extracted. No biliary strictures or malignancy were identified. Post procedure, the patient experienced symptomatic improvement and was discharged on ursodiol with outpatient gastroenterology follow-up. Conclusion: Post-cholecystectomy choledocholithiasis can occur years after surgery and may mimic neoplastic biliary disease on imaging. ERCP remains the gold standard for both diagnosis and management. This case reinforces the role of timely endoscopic intervention in preventing complications and

underscores the need for continued vigilance for biliary stone disease in post-cholecystectomy patients.

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2026 Research Recognition Day