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    Biosynthetic skin substitutes provide rapid healing in stubborn wounds


    Boston — Skin substitutes offer a number of advantages as wound dressings for persistent wounds in the elderly, according to Tania J. Phillips, M.D., professor of dermatology, Boston University School of Medicine.

    Dr. Phillips
    A primary advantage is that they are not invasive, she says.

    "They can just be applied as any other wound dressing can be," she says. "I think in the old days one would consider using a split-thickness graft on a patient, which required taking skin from another site in the body and placing it on the wound. Then the donor site was left as a wounded area."

    This was particularly problematic in elderly patients, those with immune suppression and those who were sick, she says.

    "The donor site could be very painful and often took a long time to heal. I think now that skin substitutes are readily available, they should be used first before considering split-thickness grafts," Dr. Phillips says.

    Effects on wound healing

    Dr. Phillips says Apligraf (Organogenesis) is a bilayered skin construct, approved by the Food and Drug Administration, that has been well studied in venous leg ulcers and diabetic foot ulcers.1-3 Patients were randomized to treatment with the skin substitute plus standard of care versus standard of care alone.

    "Patients healed more rapidly in the skin-substitute-treated group, and there was a higher percentage of patients healed in this group," she says.

    A nonhealing venous leg wound present for five months in an 83-year-old female patient before (left) and several weeks after two applications of Apligraf. (Photos: Tania Phillips, M.D.)
    One particularly notable finding was that patients with long-standing venous ulcers, which usually are much more difficult to heal, healed more rapidly, she says.

    When assessing the percentage of patients healed within six months (47 vs. 19 percent; P < 0.005) and the median time to complete wound closure (P < 0.005), researchers found that Apligraf treatment was significantly more effective compared with active control.2

    Two products have been FDA-approved to treat diabetic foot ulcers — Apligraf and Dermagraft (Advanced Biohealing), which is made of a bioabsorbable mesh seeded with fibroblasts.

    "That is placed within the wound as a dressing, and that also accelerates healing of diabetic foot ulcers," Dr. Phillips says.


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