Surgeons share how they evaluate whether a wound bed is ready for either an acellular dermal matrix or a skin graft
According to the Ulcerated Leg Severity score, venous leg ulcers (VLUs) smaller than 10cm2 and fewer than 12 months old at the first visit are most likely to heal within six months of care. Yet even in this best-case scenario, the predictive model holds that 20% will not heal in that time frame. 1
Meanwhile the same model found that 78% of VLUs larger than 10cm2 and older than a year will not heal within six months of care.1
How do you manage such hard-to-heal VLUs in your own practice?
In the above video, vascular surgeon Dr. John C. Lantis, Icahn School of Medicine at Mount Sinai, walks through his treatment approach to manage recalcitrant VLUs in complex patient populations. After identifying VLUs that will likely progress too slowly, Dr. Lantis uses PriMatrix® Dermal Repair Scaffold to achieve wound healing.
“Why might it be a nice therapy?,” Dr. Lantis says, “…people look at [a] venous leg ulcer and say, gee, it’s not very deep. It’s pretty superficial. But that injury is coming from the subcutaneous venous plexus through the dermis and through the epidermis, so it is a full-thickness dermal injury.”
“In addition, that wound environment has a very high level of matrix metalloproteinases and possibly even serine proteases from bacteria,” he continues. “Therefore, using a robust dermal repair scaffold such as PriMatrix may be more ideal than a cellular-based therapy.”
Watch as Dr. Lantis presents four cases of difficult-to-heal VLUs that he successfully managed using PriMatrix. He also presents data from his single center retrospective review of VLUs managed using PriMatrix, in which:
- 31% of wounds closed at 16 weeks
- The median time to closure was 67 days
- 40% of wounds had greater than 40% area reduction at four weeks
- Two or fewer applications of PriMatrix were used in 92% of the cases2
1. Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. The accuracy of venous leg ulcer prognostic models in a wound care system. Wound Repair Regen. 2004 Mar-Apr;12(2):163-8. doi: 10.1111/j.1067-1927.2004.012207.x. PMID: 15086767.
2. Paredes JA, Bhagwandin S, Polanco T, Lantis JC. Managing real world venous leg ulcers with fetal bovine acellular dermal matrix: a single centre retrospective study. J Wound Care. 2017 Oct 1;26(Sup10):S12-S19. doi: 10.12968/jowc.2017.26.Sup10.S12. PMID: 28976834.
PRIMATRIX® DERMAL REPAIR SCAFFOLD
PriMatrix is intended for the management of wounds that include partial and full thickness wounds; pressure, diabetic, and venous ulcers; second-degree burns; surgical wounds – donor sites/grafts, post-Moh’s surgery, post-laser surgery, podiatric, and wound dehiscence; trauma wounds–abrasions, lacerations, and skin tears; tunneled/undermined wounds; draining wounds.
PriMatrix should not be used for patients with a known history of hypersensitivity to collagen or bovine products.
Warnings and Precautions:
Do not expose to chemicals or substances other than sterile, room temperature 0.9% saline. Excessive heat can damage collagen. Do not hydrate in 0.9% saline warmed above room temperature. If, when hydrated, the product shrinks in size, DO NOT use the product as it may be damaged. PriMatrix should be used with caution in regions where an infection exists or is suspected. Treat any existing infection appropriately. PriMatrix should not be applied directly on third-degree burns.