Key Insights On Using Apligraf Successfully
- Volume 15 - Issue 3 - March 2002
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Q: What method would you typically use to adhere the graft to the wound bed? What dressing would you use for subsequent dressing changes?
A: All three DPMs suggest using mepitel or another product to stabilize the wound.
Dr. Armstrong says typically, he either staples the graft to the bed or simply lays it on without attachment. He says he has found some benefit in using a silicone-based non-adherent dressing, like mepitel, over the wound. Dr. Armstrong also has found great utility in pre-treating his patients for one or two weeks with a dressing which contains silver, such as Acticoat (Smith and Nephew).
“Silver, which has significant broad-spectrum antimicrobial properties, can substantially reduce the bacterial bioburden in the wound and thus improve results,” says Dr. Armstrong.
Dr. Snyder suggests using mepitel or Xeroform gauze to stabilize the graft against the wound bed and notes there are other available alternatives, including sutures, staples and steri-strips. First, Dr. Snyder says you should apply mepitel or Xeroform gauze carefully over the graft and then apply a layer of Lyofoam gauze or comparable hydrocellular dressing material. If you expect a fair amount of drainage, cut additional strips of this material and place them over the original hydrocellular dressing. Apply gauze, a gauze roll and Coban. If you are treating a patient with venous ulcer disease, Dr. Snyder says the compression should go from behind the toes to below the knee. He recommends keeping the dressing in place for five to seven days and repeating it every time you change the dressing.
Dr. Ross says he likes using the “old-fashioned” method of suturing his grafts in place with simple nylon sutures. He puts a piece of mepitel over the wound and places sterile, saline-soaked cotton balls over the mepitel in the wound to ensure good adherence between the graft and wound bed. Dr. Ross then covers it with four-by-fours and secures it with kling. Then he utilizes a compression bandage, anything from Profore to simple tubgrip, depending on the patient’s vascular status. Dr. Ross says subsequent dressings will consist of non-adherent dressing, often Vasoline-impregnated gauze and kling.
Q: Has Apligraf been of significant value to your patients? How often do you have to reapply the grafts to accomplish healing?
A: Dr. Snyder and Dr. Ross say patients have found Apligraf beneficial. Dr. Snyder says he reapplies the product for “extremely recalcitrant wounds,” but will wait six weeks before doing it. Dr. Ross rarely has had to reapply a graft. Usually, Dr. Armstrong uses one or two applications of Apligraf.
“Many wounds that were previously resistant to healing or required autograft can now be treated safely and expeditiously in an office setting with consistent results,” emphasizes Dr. Snyder.
Dr. Snyder (shown below) is a Diplomate of the American Board of Podiatric Surgery and the American Academy of Wound Management. Dr. Armstrong is the Director of Research and Education within the Department of Surgery, Podiatry Section at the Southern Arizona Veterans Affairs Medical Center. Dr. Ross is a Diplomate of the American Academy of Wound Management.
1. Snyder RJ. Graftskin (Apligraf) and regranex gel: an overview. Podiatry Management. November/December 2001: 39-50.
2. Falanga V, et. al. Prognostic factors for healing venous and diabetic ulcers. Wounds 2000; 12 (5 supplement): 42A-46A.