Post-Acute Pressure Injury Care: When to Add dHACM

Adjunctive Dehydrated Human Amnion Chorion Membrane for Pressure Injuries in the Post‑Acute Setting: What a Two‑Case Series Shows

Disclaimer: Educational content only; not a substitute for individual medical judgment.

Key takeaways

(Patient with sacral pressure injury, initial visit)

Who & where: Two elderly, multi‑morbid patients with pressure injuries >1 year old transitioned from hospital outpatient (HOPD) care to home‑based, mobile wound care. [1, 2]

What changed: After standard care (serial debridement and compression when needed) stalled, clinicians added dehydrated human amnion/chorion membrane (DHACM; EpiFix®) weekly to biweekly. [6, 3]

(Patient injury closure after four months)

Outcomes: Durable closure within 4 months for both wounds under the mobile‑care protocol. [8, 2]

Why it matters: Post‑acute patients—older, less mobile, and on multiple medications—have high recurrence risk after discharge; integrating DHACM into post‑acute workflows may help close long‑standing PIs when conservative care alone is not enough. [8, 2]

Why focus on post‑acute pressure injuries now?

In 2023, 323,000 Medicare beneficiaries filed roughly 900,000 claims for pressure‑injury (PI) treatment. Many are discharged before durable closure or recur, then move through long‑term hospitals, inpatient rehab, skilled nursing, or home‑based care—settings where mobility limits and polypharmacy compound risk. A mobile wound‑care team reported two such patients whose year‑long PIs finally closed after adding DHACM in the home. [8, 2]

What the team did (replicable elements)

Setting & tracking

• Mobile onsite clinicians followed patients in their homes after prior HOPD care.

• At each visit: documented treatments, wound characteristics, and size to confirm trajectory.

Foundational care first

• Continued standard care: debridement; compression when indicated.

• Declared a “stall” when appropriate fundamentals failed to move area or bed quality.

Adjunctive biologic

• Initiated DHACM (EpiFix®) at weekly–biweekly intervals until closure was observed.

• Time to closure: ≤ 4 months for both long‑standing PIs.

Clinical implications for wound programs

1) Make the post‑acute handoff intentional

Treat discharge as the midpoint—not the finish line. Patients with advanced age, low mobility, and multiple comorbidities are at greater risk of recurrence and may benefit from proactive escalation pathways in the home or SNF. [8, 2]

2) Use DHACM as an adjunct after a true stall

This series used DHACM after consistent debridement/compression failed to produce progress, aligning with an “adjunctive after‑stall” approach rather than a first‑line substitution. [6, 3]

3) Expect pragmatic cadence

The team applied DHACM weekly to biweekly, reassessing bed quality and size at each encounter—simple, repeatable, and compatible with mobile workflows. [8, 2]

A simple post‑acute workflow you can pilot

1. Re‑baseline at first post‑acute visit

   • Confirm PI staging, measure area, document bed quality. [1, 2]

   • Continue debridement; apply compression when indicated. [1]

2. Define “stall”

   • No meaningful progress despite fundamentals over a reasonable interval. (The series escalated after conservative care failed.)

3. Add DHACM

   • Apply weekly–biweekly; keep photo/area trends to verify effect. [6, 4]

4. Stay mobile‑care friendly

   • Build a cadence that fits home visits and caregiver capacity. [6]

5. Declare success

   • Continue until durable closure; plan recurrence prevention and follow‑up. [3, 9]

Strengths, limits, and how to talk about it with stakeholders

• Strengths: Real‑world, post‑acute/home‑based context; practical cadence; closure of year‑long PIs within 4 months after adding DHACM. [8, 2]

• Limitations: n=2, single program; not a comparative study; product noted (EpiFix®) and one author affiliation with manufacturer (MIMEDX) listed—interpret with appropriate caution. [6, 3]

• Bottom line for leadership: In carefully selected stalled PIs, adjunctive DHACM integrated into the post‑acute algorithm may shorten the path to closure and reduce revolving‑door utilization after discharge. [8, 2]

FAQ

What is DHACM and how was it used here?
DHACM (dehydrated human amnion/chorion membrane; EpiFix®) is a placental‑derived biologic used here as an adjunct to standard PI care after a stall, applied weekly to biweekly in the home until closure. [1, 2]

Did DHACM replace debridement or compression?
No. Debridement (and compression when indicated) continued; DHACM was added when conservative therapy alone failed to make progress. [6, 3]

How fast did the wounds close?
Both year‑long PIs achieved durable closure within 4 months after adding DHACM in the mobile‑care program. [8, 2]

Why emphasize post‑acute and home‑based care?
Older, less mobile, multi‑morbid patients discharged from hospital are at high risk for non‑closure or recurrence; a structured post‑acute plan with escalation (e.g., DHACM after stall) can address this gap. [8, 2]

Bottom line

For post‑acute patients with stalled, year‑long pressure injuries, adding DHACM to sound fundamentals in a home‑based, mobile‑care model coincided with closure within 4 months in this small series. Consider a defined escalation pathway to DHACM once conservative therapy truly stalls in the post‑acute setting. [1, 2]

References

[1] EPUAP/NPIAP/PPPIA 2019 Clinical Practice Guideline: Prevention and Treatment of Pressure Ulcers/Injuries — https://epuap.org/pu-guidelines/

[2] AHRQ: Preventing Pressure Ulcers in Hospitals (burden & cost) — https://www.ahrq.gov/patient-safety/settings/hospital/resource/pressureulcer/tool/pu1.html

[3] Berhane CC et al., 2019. dHACM for pressure ulcer treatment: case series. J Wound Care — https://www.magonlinelibrary.com/doi/abs/10.12968/jowc.2019.28.Sup5.S4

[4] Serena TE et al., 2022. Multicenter RCT of dHACM + compression (weekly/biweekly) in chronic VLUs. Wound Rep Reg — https://pmc.ncbi.nlm.nih.gov/articles/PMC9586828/

[6] NICE MIB139: EpiFix for chronic wounds (incl. pressure ulcers); weekly application — https://www.nice.org.uk/guidance/mib139/resources/epifix-for-chronic-wounds-pdf-2285963404096453

[8] Wiley Wound Repair Regen 2023: Risk factors for pressure ulcer recurrence — https://onlinelibrary.wiley.com/doi/10.1111/wrr.13110

[9] Narayan N et al., 2025. RCT: dHACM vs collagen-based substitute in Stage III–IV pressure ulcers — https://pubmed.ncbi.nlm.nih.gov/40862036/