2005 Symposium on Advanced Wound Care | |
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Case Study
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Healing of stage IV pressure ulcers using bi-layered cellular therapy Andrew Hanflik, BS, David Kaplan, PA, Hyacinth Entero, BS, Columbia Wound Healing Program, Columbia University Medical Center, New York, NY; and Harold Brem, MD, Director Wound Healing Program, Columbia University College of Physicians and Surgeons, New York, NY Case Study. Bi-layered cellular therapy* is FDA approved based on efficacy for healing multiple types of chronic wounds. This therapy is essentially the application of living human keratinocytes and fibroblasts to the wound. Previously, we demonstrated it to be a highly efficacious treatment for stage II and III pressure ulcers.It has become a standard of care for stage II and III pressure ulcers that are not rapidly healing. In twostage IV cases who presented with undermining and osteomyelitis, one palliative, the other a patient refusing a muscle flap, we utilized bilayered cellular therapy. Treatment. Deep surgical debridement was performed to the level where all nonviable and infected tissue, including bone was excised. Wound margins were extended into healthy tissue adjacent to the wound bed. After multiple debridements, bi-layered cellular therapy was applied to all wound surfaces. It was laid on the underlying surface and bone. Post-operative systemic antibiotic courses were determined by deep culture. Outcome. Both patients healed after debridement followed by application of Bi-layered cellular therapy. In clinical practice, bi-layered cellular therapy is an effective treatment in preventing stage II and III ulcers from progressing. It may also be a promising technology in stage IV pressure ulcers. * Apligraf (Organogenesis; Canton, MA) References Falanga V, Margolis D, Alvarez O, et al. Rapid healing of venous ulcers and lack of clinical rejection with an allogeneic cultured human skin equivalent. Arch Dermatol. 1998;134:293–300. Veves A, Falanga V, Armstrong DG, Sabolinski ML. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care. 2001;24:290–295. Brem H, Young J, Tomic-Canic M, Isaacs C, Ehrlich HP. Clinical efficacy and mechanism of bilayered living human skin equivalent (HSE) in treatment of diabetic foot ulcers. Surg Technol Int. 2003;11:23–31. Brem H, Balledux J, Bloom T, Kerstein MD, Hollier L. Healing of diabetic foot ulcers and pressure ulcers with human skin equivalent: a new paradigm in wound healing. Arch Surg. 2000;135:627–634. Brem H, Jacobs T, Vileikyte L, et al. Wound-healing protocols for diabetic foot and pressure ulcers. Surg Technol Int. 2003;11:85–92. |
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