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

Howard Kimmel, DPM, and Alexander Reyzelman, DPM

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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.

   Several studies have shown that fibroblasts taken from chronic ulcers demonstrate low proliferative capacity and what is referred to as senescence. It is postulated that the ulcer environment is responsible for the senescence.1


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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