Advanced Wound Healing with Cadaveric Grafts in Ischemic and Complex Wound: A Single Centre Experience

Purpose: To evaluate the safety and efficacy of cadaveric skin and dermal grafts from skin banks in the management of hard-to-heal wounds (HHWs), particularly of vascular etiology, in a frail patient population. Methods: This prospective, single-center study enrolled 48 patients with HHWs unresponsive to conventional care. Patients underwent vascular assessment, revascularisation if indicated, and wound bed preparation prior to application of cryopreserved, glycerol-preserved, or lyophilized cadaveric grafts. Outcomes were assessed at predefined intervals up to 10.5 months. Results: A total of 48 patients were enrolled. Arterial etiology was the most prevalent (33 patients, 68.7%). Complete wound healing was achieved in 47.9% of patients, with a mean time to re-epithelialization of 106.6 days. Limb salvage was attained in 97.9% of cases. Significant pain reduction was observed, with VAS scores dropping from 6.8 ± 1.9 at baseline to 1.5 ± 2.7 at six months (p < 0.0001). The Falanga A wound bed category increased from 42.5% at baseline to 84% at 6 months, and infection rates declined from 42.5% to <12% during follow-up. Subgroup analysis showed superior healing outcomes among arterial HHWs compared to non-arterial HHWs (p < 0.05). Conclusion: Cadaveric skin bank bioproducts offer an effective and safe option for the treatment of hard-to-heal wounds, particularly in patients with vascular disease. In this cohort, the approach led to a high rate of complete healing and limb salvage with significant pain reduction and enhanced wound bed quality. These results highlight the therapeutic value of allografts when used as part of an integrated protocol that includes revascularisation and meticulous wound bed preparation.