Point-Counterpoint: Are Acellular Dermal Matrices More Effective Than Fibroblast-Derived Dermal Substitutes?

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Author(s): 
Howard Kimmel, DPM, and Alexander Reyzelman, DPM

   Dr. Kimmel is a Diplomate of the American Board of Podiatric Surgery. He is the Director of Residency Training at the Department of Veterans Affairs in Cleveland, Ohio. Dr. Kimmel is the Senior Clinical Instructor in the Department of Surgery at Case Western Reserve University School of Medicine in Cleveland.

References
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5. Marston WA, Hanft J, Norwood P, Pollak R, Dermagraft Diabetic Foot Ulcer Study Group. The efficacy and safety of Dermagraft in improving the healing of chronic diabetic foot ulcers: results of a prospective randomized trial. Diabetes Care. 2003;26(6):1701-5.
6.  Veves A, Falanga V, Armstrong DG, Sabolinski ML, Apligraf Diabetic Foot Ulcer Study. Graftskin, a human skin equivalent, is effective in the management of noninfected neuropathic diabetic foot ulcers: a prospective randomized multicenter clinical trial. Diabetes Care. 2001;24(2):290-5.
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No.

This author says the role that fibroblasts play in facilitating the healing of chronic wounds is well established whereas questions abound for acellular dermal matrices, which lack high-quality supporting evidence.

By Alexander Reyzelman, DPM

The field of bioengineered tissue has significantly expanded during the last decade. In addition to living skin substitutes, we now have access to many acellular dermal matrices. It is becoming more and more important to have a better understanding of the role these wound healing modalities play in our treatment armamentarium.

   The success of fibroblast-derived dermal substitutes is based on the premise that there are living dermal fibroblasts seeded on to a scaffold, which one then applies to the wound. These living dermal fibroblasts are able to secrete growth factors, deposit matrix proteins and facilitate epithelial cell migration.

   There are multiple reasons for the failure of the wound healing process but in order to understand how fibroblast-derived dermal substitutes may help, it is important to understand the role that fibroblasts play in the non-healed wound.

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Anonymous, DPMsays: May 26, 2013 at 11:43 am

And how much does all this cost the patient or insurance company? Do you think this will be covered in those patients with the cheapest Obama care plans? Buehler? Buehler? Hello?
Will podiatry continue this treatment when it is no longer reimbursable? Oh, it really wasn't all that effective anyway.

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