A Closer Look At Plastic Surgery Techniques

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Author(s): 
Clinical Editor: Lawrence Karlock, DPM

Q: What are your thoughts about new bioengineered skin equivalents? How do these compare with split thickness and full-thickness skin grafting in managing neuropathic ulcers?
A:
Dr. Karlock notes he commonly uses Apligraf and has been pleased with the results. He says Apligraf is user-friendly, applicable in an office setting and you don’t have to worry about the lack of a donor site.
While bioengineered skin equivalents like Apligraf and Dermagraft can help facilitate a healthy granulating wound bed for further skin grafting, Dr. Blume says these products are not the true equivalent of a skin graft. Dr. Storm agrees. When these products are used appropriately, Dr. Storm says they provide instant biological coverage and speed ulcer closure by providing needed wound healing substrates. However, he says they do not provide the “rapid” take of a graft.
In regard to neuropathic ulcers, Dr. Storm says he rarely uses skin grafts since these ulcers are usually on weightbearing surfaces and the graft will commonly fail when the patient begins walking. While Dr. Storm says he has not used skin equivalents for these ulcers, he would consider doing so if the patient is not a surgical candidate. He adds that his experience with the skin equivalents is limited to venous stasis ulcers, and does feel that they heal the ulcers faster than dressings alone.
However, Drs. Blume and Storm concur that there is no equivalent for split-thickness skin grafting for reconstruction of foot wounds.

Dr. Blume is a Clinical Assistant Professor within the Department of Orthopaedics and Rehabilitation at the Yale School of Medicine. He is the Director of Limb Preservation at the Yale New Haven Hospital in New Haven, Ct.

Dr. Storm is a Fellow of the American College of Foot and Ankle Surgeons and is board-certified by the American Board of Podiatric Surgery. He has a private practice in Bozeman, Mt.

Dr. Karlock (pictured at the right) is a Fellow of the American College of Foot And Ankle Surgeons, and practices in Austintown, Ohio.

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