2005 Symposium on Advanced Wound Care | |
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Case Study
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Early treatment and rapid healing of venous ulcers less than one year in duration, by application of bi-layered cellular therapy* Andrew Hanflik, BS, David Kaplan, PA, Hyacinth Entero, BS, Columbia Wound Healing Program, Columbia University Medical Center, New York, NY; Harold Brem, MD, Director Wound Healing Program, Columbia University College of Physicians and Surgeons, New York, NY Introduction. Venous ulcers may affect up to 2.5 millions patients in the United States each year. Caused by venous reflux, these wounds are often painful, debilitating, life-altering and lead to hospitalizations for cellulitis and other complications. With efficacy ranging from 47%-78%, bi-layered cellular therapy remains the standard of care for venous ulcers greater than one year duration.1-3 Over a typical 8 day period in our out-patient wound center, we treated 6 consecutive patients with non-healing wounds of greater than 1 month duration. They all healed rapidly. Methods. Debridement in the wound center was performed utilizing local anesthesia in all 6 cases. Nonviable tissue was excised, wound margins were extended a few millimeters into healthy tissue and bi-layered cellular therapy applied to the wound bed. Systemic antibiotics were prescribed before surgery and deep cultures were used to dictate the post-surgical course. All patients continued to receive compression therapy. Results. Bi-layered cellular therapy was effective in healing all cases. Based on this recent data and previous experience, we now use this treatment in ulcers demonstrating greater than 4 weeks of non-healing. We hypothesize that early use of Bi-layered cellular and compression therapies will eliminate venous ulcers of greater than one year duration. * 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(3):293–300. Falanga V, Sabolinski M. A bilayered living skin construct (APLIGRAF) accelerates complete closure of hard-to-heal venous ulcers. Wound Repair Regen. 1999;7(4):201–207. Brem H, Balledux J, Sukkarieh T, Carson P, Falanga V. Healing of venous ulcers of long duration with a bilayered living skin substitute: results from a general surgery and dermatology department. Dermatol Surg. 2001;27(11):915–919. |
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