Key Insights On Using Apligraf Successfully
Q: In your experience, does Apligraf actually “take” like an autograft? What would you expect to see on the first post-operative visit?
A: In his experience, Dr. Ross says there have been many cases in which Apligraf took like an autograft. However, Dr. Armstrong disagrees, saying he believes many people made mistakes initially because of their expectations in terms of what to look for.
“What was once considered by some to be ‘slough’ on the wound one to two weeks post-grafting is now known to be metabolically active graft,” explains Dr. Armstrong. “One should not disturb this until it dissipates. Other bioengineered products, such as Dermagraft, behave differently in the wound. Therefore, there is definitely an observational as well as a mild technical learning curve to overcome in order for these modalities to reach their full therapeutic potential.”
Dr. Ross always tells his patients to expect their grafts either to take like regular skin grafts or act as wound dressings to promote better healing. “I like to check the graft site after four days, so I almost always see a normal appearing graft site, that is one with normal appearing skin as a graft,” offers Dr. Ross.
For Dr. Snyder, the topic of Apligraf taking like an autograft is “somewhat controversial.” He says Apligraf likely incorporates into the wound and does not take in the traditional sense, leading to a different clinical appearance, especially on the first few dressing changes, the first of which typically is in five to seven days.
“Therefore, the wound may have a slight malodor and occasionally the graft appears to be sloughing off,” explains Dr. Snyder. “The surrounding tissue may be somewhat macerated. This clinical appearance is usually no cause for alarm and, in most cases, does not represent infection.”
If you see no signs of clinical infections, Dr. Snyder warns to resist the temptation of debriding away the graft, culturing the wound which remains and starting the patient on antibiotics, pending results of the cultures. Instead, he recommends you see the patient more frequently and carefully monitor him or her. He says in most cases, the graft will start to solidify and incorporate itself into the wound bed.