Exploring The Potential Of Bioengineered Alternative Tissues

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This intraoperative photo shows a chronic wound after debridement. The surgeon has applied Integra. Paul Kim, DPM, says Integra works well in deeper wounds and decreases the overall wound depth. (Photo courtesy of Paul Kim, DPM, and John Steinberg, DPM)
Here one can see the aforementioned wound six weeks after the application of Integra. (Photo courtesy of Paul Kim, DPM, and John Steinberg, DPM)
Exploring The Potential Of Bioengineered Alternative Tissues
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Author(s): 
Clinical Editor: Lawrence Karlock, DPM

Q: Do you have any pearls when it comes to post-op dressings with these products?
A:
Dr. Miller prefers using Versatile 1 (Blue Sky Medical) due to its lower pressures and ease of use. He adds that several of his colleagues have had satisfactory results with it. For him, the keys are constant negative pressure to “secure” the graft down and enhance healing. He feels this results in faster and better “take,” and ultimately quicker recovery and ambulation for the patient.
As far as BAT products go, Dr. Kim is mainly concerned with their stability in the wound bed following application. He recommends tacking the BAT down with staples or stitches around the edge of the wound. Dr. Kim also says one can find success by using non-adherent dressings like Mepitel® or Adaptic® over the bioengineered alternative tissues. He advises using a porous dressing since it will permit the exudates to drain from the wound. When it comes to an outer dressing, if one is not using negative pressure wound therapy, Dr. Kim suggests using any combination of a dressing sponge with Kerlix® or Kling®.
For Dr. Steinberg, the choice is straightforward. One should use a nonadherent dressing for the first layer, an antimicrobial dressing for the second layer and a dressing that retains moisture for the third layer. He says deeper wounds often necessitate VAC therapy to manage the drainage appropriately and to keep the graft material adherent to the wound base.

Dr. Kim is an Associate of the American College of Foot and Ankle Surgeons. He is an Assistant Professor at Midwestern University College of Health Sciences.
Dr. Miller is certified in chronic wound management and board certified in general surgery. He is the Medical Director of four wound healing centers in Indiana.
Dr. Steinberg is a Fellow of the American College of Foot and Ankle Surgeons. He is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C.

Dr. Karlock (pictured) is a Fellow of the American College of Foot and Ankle Surgeons, and practices in Austintown, Ohio. He is a member of the Editorial Advisory Board for WOUNDS, a Compendium of Clinical Research and Practice.




References:

References
1. Sheehan P, Jones P, Caselli A, Giurini JM, Veves A. Percent change in wound area of diabetic foot ulcers over a 4-week period is a robst predictor of complete healing in a 12-week prospective trial. Diabetes Care 2003 Jun;26(6):1879-1882.

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