#12 CAN A TISSUE ENGINEERED SKIN GRAFT IMPROVE
HEALING OF LOWER EXTREMITY FOOT WOUNDS FOLLOWING
REVASCULARIZATION?
David W. Chang, MD, Luis A. Sanchez, MD, Frank J. Veith, MD, Reese A.
Wain, MD, Takao Ohki, MD and William D. Suggs, MD.
Montefiore Medical Center/Albert Einstein College of Medicine, New
York, NY.
Objective: Apligraf, a tissue engineered skin substitute composed of
human fibroblasts and keratinocytes in a collagen matrix, has been
shown to significantly improve healing of venous stasis ulcers. The
goal of the present study was to determine if this human skin
analogue can improve healing of previously ischemic arterial wounds
following revascularization. In addition, we sought to evaluate
whether meshed or unmeshed grafts were superior in this setting.
Methods: Patients with foot wounds who underwent angioplasty or
bypass within 60 days were eligible for inclusion. Thirty-five
granulating wounds including heel ulcers, toe and transmetatarsal
open amputation sites were randomly assigned to receive conventional
twice daily moist dressing changes, unmeshed Apligraf or meshed
Apligraf. Grafts were placed in an outpatient setting with a
xeroform and gauze dressing protected by a gelocast boot. The
treated extremity was kept non-weight bearing and examined at 5-7 day
intervals. Wound size was documented by photography and quantified
by wound area measurements.
Results: Sixty-four percent of grafted wounds retained graft
coverage and appeared healed, whereas wound coverage was never
achieved with ungrafted wounds (p<0.001) over the course of 2
months. Sixty-two percent of meshed grafts and 69% of unmeshed
grafts (p>0.5) resulted in a completely healed wound after a
single application of Apligraf. Engraftment initially consisted of
cellular and dermal elements that matured over 3 to 4 weeks.
Complete graft loss occurred only in 2 of 26 wounds (7%) and was
associated with indolent infection confined to the graft site.
Conclusion: These results suggest that tissue engineered skin grafts
can promote healing of previously ischemic arterial wounds after
revascularization. The use of this skin graft obviates the need for
donor skin harvesting and anesthesia, permitting a minimally invasive
procedure that reduces wound care and hastens full recovery of the
revascularized patient. The use of meshed grafts appears
advantageous on a cost basis.
