How A New Ulcer Repair Graft Facilitates Healing

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Here is an intraoperative view of the GraftJacket, which “supports rapid revascularization and cellular repopulation,” according to the manufacturer.
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By Brian McCurdy, Associate Editor

Ulcer management and repair is an important aspect of podiatric practice. When it comes to facilitating ulcer treatment, there are regenerative tissue matrices that one may use. Easy application is a must in such products and it’s also important to ensure even healing in the affected area. It’s also an advantage when the graft you select has a number of potential applications.
With this in mind, one may want to consider the GraftJacket scaffold (Wright Medical), a human dermal membrane that has won raves from podiatrists.

GraftJacket’s ease of use and single application are advantages, according to Steven Boc, DPM, and Stephen Brigido, DPM. Dr. Boc, the Chairman of the Department of Foot and Ankle Surgery and Director of Residency Training at St. Agnes Medical Center in Philadelphia, calls the meshed graft “extremely easy to use,” noting it has a hydration period of about 10 minutes and you can easily cut and size it using a scalpel or surgical scissors. It measures 4 by 4 cm.
According to the manufacturer, the GraftJacket is composed of biological substrate components, including collagen types I, III, IV and VII, elastin, chondroitin, sulfate, proteoglycans, hyaluronic acid, laminin and tenacin. Wright Medical notes the graft’s processing technology preserves its biochemical and three-dimensional structure. It adds that although the GraftJacket is freeze-dried, its technology prevents the formation of damaging ice crystals. As a result, the company says the extracellular framework remains totally intact and the vascular channels are preserved, which supports rapid revascularization and cellular repopulation.

Assessing The Technological Advantages
Dr. Boc says the fact that the vascular channels remain intact is a plus as this allows the healing to spread across the entire matrix. “This, coupled with the ability of the microvascular supply to rapidly incorporate into the vascular channels, allows for the wound to reduce in size, in length, width and depth,” he says.
Moreover, the graft’s careful processing ensures all cellular components have been extracted and the matrix is free of all immune response targets.
“It’s tolerated well by the patients,” points out Dr. Boc. “There have been zero immune responses or problems.”
Both DPMs cite the graft’s tensile strength as an advantage in wound repair. “It’s been our experience that the strength of the graft allows for a more stable healing environment especially in the neuropathic patient,” explains Dr. Boc, noting they have had particular success using the matrix on diabetic patients.

A Closer Look At Possible Indications
Dr. Boc uses GraftJacket on partial and full thickness ulcers, bone defects and to repair tendons and ligaments as well as Achilles tendon ruptures as an alternative to more traditional cadaver graft or aponeurosis flaps. He calls the product “an excellent tool to augment an attenuated tibialis posterior tendon in the adult acquired flatfoot.”
GraftJacket’s uniqueness stems from the fact that you can use its scaffold structure on bone, tendon and skin, according to Dr. Brigido, a Chief Resident at St. Agnes Medical Center. He says you can also use the graft for bone graft containment in the long bones of feet, ankles and legs. Dr. Boc frequently uses the product to treat nonunions in the tibial diaphysis, in the metatarsals where bone grafts are necessary and also to augment the cortical window when he performs osseous tumor resection.
“It’s been a real boon to us in a number of areas,” says Dr. Boc.

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