FloGraft^® is human allograft derived from prescreened, live, healthy donors comprised of chorion-free amnion and amniotic fluid. The tissue is used clinically as an adjunct to surgical and non-surgical procedures.

FloGraft^®, an Applied Biologics product, is implanted in the body using a 22 gauge needle. The graft comes cryopreserved and is thawed out five minutes prior to implanting it. The amniotic fluid contains growth factors, amnion epithelial cells and mesenchymal stromal cells, collagen type I, II, III, IV and V and interleukin 10. It also contains hyaluronic acid, cytokines and native organic nutrients. The amniotic fluid contains these factors that are responsible for anti-inflammatory, anti-adhesive and anti-microbial properties.

FloGraft^® is used in the foot and ankle for various conditions such as plantar fascial tears, Achilles tendonopathies, acute and delayed healing fractures, tendon repair, nerve repair, ligament repair and intra-articular conditions.

Case Report

A 45-year-old male had a previous sprained ankle with chronic pain post six months after his inversion ankle sprain. He twisted his ankle while playing basketball and landed on top of another player’s foot. He felt a pop within his ankle at the time of the injury. He initially presented in the office with severe swelling of his ankle and with minimal range of motion. At that time, conservative therapy was instituted. This included initial immobilization in a camwalker boot, NSAIDS and physical therapy.

X-rays were negative at that time for any bony pathology.

After six months of conservative therapy, he presented to the office still in severe pain with what he explained as a feeling of instability with the right ankle.

The physical examination at that time revealed no demonstratable ankle instability, only severe pain on inversion and eversion range of motion. There was pain elicited in the medial aspect and gutter of the ankle upon palpation and range of motion.

The MRI was positive for an Osteo-Chondral Talar Dome lesion approximately 8-10 mms.

It was determined to perform a diagnostic injection of 5cc of 1% Lidocaine plain to see if his symptoms within the ankle joint could be pain free temporarily.  This would be diagnostic of an internal intra-articular derangement problem with the ankle joint. The injection in fact did relieve his painful ankle for two hours.

It was determined at this time that the patient would need surgery. I felt an Ankle Arthroscopy with micro fracture of the lesion was necessary and was subsequently performed. Implantation of FloGraft^® was to be performed as well.

The patient consented to this procedure.

Surgical treatment consisted of an Ankle Arthroscopy with micro-fracture of the talar dome lesion. As an adjunct, 1cc of FloGraft^® diluted with 4cc of plain Lidocaine and Marcaine was implanted-after arthroscopic ports closed, within the ankle joint.

The patient was initially immobilized in a cam walker for four weeks post-operative. He received physical therapy one week post operatively.

At the four week follow up, the patient was full weight bearing and pain free.

An MRI was performed three months post-operatively and showed complete healing of the talar dome lesion

In conclusion, FloGraft^® is a significant adjunct to any arthroscopic surgery of the Foot and Ankle. I feel the FloGraft® tissue promoted earlier than expected articular cartilage healing in this patient.

Currently there are 20 similar patients that have undergone post-operative Ankle Arthroscopy with FloGraft®. The results are all similar.

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Amniotic Membrane & Fluid: A Biologic System FloGraft® is human allograft derived from prescreened, live, healthy donors comprised of chorion-free amnion and amniotic fluid. The tissue is aseptically recovered, processed and cryopreserved to provide well-preserved human tissue for clinical use as a soft-tissue defect filler. Amniotic membrane and fluid act as a biologic system that ensures symmetrical structure development and growth; cushions and protects the embryo; has a significant defensive role as a part of the innate immune system, and protects the fetus by maintaining consistent pressure and temperature. As a liquid allograft, FloGraft® retains this protective function by acting as a tissue matrix for use in filling soft tissue defects, or for points of localized inflammation.

To learn more about Applied Biologics FlōGraft®, and its products and services, please contact us.