Here is a step-by-step approach of the standard technique we use for applying Dermagraft at the High Risk Diabetic Foot Center at the Southern Arizona Veterans Affairs Medical Center.
Step 1: Unpack. Dermagraft comes shipped on dry ice. Do not open the box until you are ready to apply the graft. Once you remove it from the box, the Dermagraft pouch is now immediately ready for the thaw phase.
Step 2: Thaw. Proceed to thaw the Dermagraft (in pouch) in warm water (approximately 37ºC) for two to three minutes or until you no longer see any ice crystals. You may perform the thaw phase in the basin, which is usually shipped alongside the Dermagraft box. Once this is complete, continue to the rinse phase.
Step 3: Rinse. Remove the pouch containing the Dermagraft from the warm water basin and transfer it into the specialized Dermagraft rinse container. You may open the top of the pouch with scissors. Use normal saline to rinse the Dermagraft of any preservatives that may still be present after the thaw phase. You should repeat this three times.
Step 4: Trace and cut. You may now remove the open pouch from the specialized Dermagraft rinse container, place the pouch against the wound and trace the wound with a felt-tipped marker. You may also want to trace out a small “tab,” which can help you handle the Dermagraft once it is cut out. Now you can cut out the Dermagraft (including the “tab”), removing the two sides of the remaining pouch to expose the active Dermagraft. You are now ready to place the graft.
Step 5: Apply. Handle the graft with sterile gloves or with atraumatic instrumentation and place it over the wound. You can use cotton-tipped applicators to improve contact with the wound bed and remove any air bubbles between the graft and the wound. We are now ready for our secondary dressings.
Step 6: Dress. We typically will apply a non-adherent gauze dressing (mepitel, conformant) and follow up with a pre-moistened silver-containing dressing (Acticoat-7 or Acticoat Absorbant). Then we apply a foam dressing (Allevyn) and/or standard moistened gauze. If you plan on putting the patient into a total contact cast for a plantar wound, you should limit the bulk of the dressing as much as possible and avoid any dressings that require wrapping around the circumference.
We will typically apply a tacky tape (hypafix) to the above-mentioned construct on the plantar foot in lieu of any type of wrap. If you are using another type of offloading modality, such as a removable cast walker, you may use a more bulky bandage. We will typically have patients return in three to five days for their first dressing changes. We rarely re-debride the wound at that time. At that visit, consider another application of Dermagraft or merely reapply the aforementioned dressing over the wound.