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

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78
Author(s): 
Howard Kimmel, DPM, and Alexander Reyzelman, DPM

In Conclusion

The above paragraphs demonstrate the effect that fibroblast-derived dermal substitutes have on a chronic wound. However, to a wound care practitioner, successful clinical outcomes are much more important. We learn to practice evidence-based medicine when treating our patients. Based on the level of evidence pyramid, randomized controlled trials are considered to be the best level of evidence.

   At this time, when one compares the level of high quality clinical evidence between acellular dermal matrices and fibroblast-derived dermal substitutes, the pendulum swings to the fibroblast-derived dermal substitutes.

   There are only three wound care products that have received premarket approval for diabetic foot ulcerations and two of these are skin substitutes. There are many acellular dermal matrices on the market and unfortunately high quality clinical trial data in chronic lower extremity wounds does not yet exist for the majority of the acellular dermal matrices.

   Dr. Reyzelman is an Associate Professor in the Department of Medicine at California School of Podiatric Medicine at Samuel Merritt University in Oakland, Calif. He is the Co-Director of the University of California, San Francisco Center for Limb Preservation.

References
1. Stanley AC, Park, HY, Phillips TJ, Russakovsky V, Menzonian JO. Reduced growth of dermal fibroblasts from chronic venous ulcers can be stimulated with growth factors. J Vasc Surg 1997; 26(6):994-1001.
2. Mansbridge J, Liu K, Pinney E, et al. Growth factors secreted by fibroblasts: a role in healing diabetic foot ulcers. Diabetes Obes Metab 1999; 1(5):265-79.
3. Chen WY, Rogers AA, Lydon MJ. Characterization of biological properties of wound fluid collected during early stages of wound healing. J Invest Dermatol 1992; 99(5):559-64.
4.  Falanga VF, Grinnel B, Gilchrest Y, Maddox T, Moshelle A. Experimental approaches to chronic wounds. Wound Repair Regen 1995; 3(2):132-40.
5. Data on file, Regranex, Healthpoint Biotherapeutics.
6.  Van der Veen VC, van der Wal MB, van Leeuwen MC, Ulrich MM, Middelkoop E. Biological background of dermal substitutes. Burns. 2010; 36(3):305-321.
7. De Vries HJ, Mekkes JR, Middelkoop E, Hinrichs WL, Wildevuur CR, Westerhof W. Dermal substitutes for full-thickness wounds in a one-stage grafting model. Wound Repair Regen. 1993; 1(4):244-252.

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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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