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Could Acellular Human Reticular Dermis Be Beneficial For Chronic DFUs?

By Brian McCurdy, Managing Editor, Podiatry Today

An abstract submitted to the Symposium on Advanced Wound Care Spring/Wound Healing Society (SAWC Spring/WHS) notes that applying acellular human reticular dermis weekly can effectively treat non-healing diabetic foot ulcers (DFUs).

The abstract authors assessed 40 consecutive patients with non-healing ulcers between 1 and 25 cm2. If wounds did not reduce in size by 20 percent after two weeks of offloading and moist wound care, patients subsequently received either standard of care alginate wound therapy or weekly applications of wound size-specific acellular human reticular dermis.

At the end of the 12-week follow-up, the abstract authors note 16 of 20 patients healed completely with the human dermis in comparison to four of 20 patients with the standard of care dressing. The mean time to healing was 39.6 days for the human dermis cohort and 77 days for standard of care patients, according to the study abstract.

Abstract co-author Charles Zelen, DPM, notes that AlloPatch Pliable (Musculoskeletal Transplant Foundation), the main treatment modality in the study, is a novel acellular dermal matrix that is aseptically processed and derived from the reticular layer of the skin, a layer that has a more consistent, open architecture than the superficial layer with key matrix proteins (collagens and elastin) similar to those in unprocessed tissue. Dr. Zelen says the reticular dermal scaffold’s extracellular elements are naturally retained through the aseptic process that contributes to favorable interactions between the cell and extracellular matrix, regulating tissue function and supporting wound healing.

“Accordingly, I feel the deeper cut of the dermis is more advantageous to wound healing when compared to the many superficial dermal grafts that are on the market,” says Dr. Zelen, who is in private practice at Foot and Ankle Associates of Southwestern Virginia.

Another advantage of AlloPatch Pliable is the availability of the graft in multiple sizes in contrast to other grafts that only offer one size. Dr. Zelen says this allows “the clinician to choose the graft size most appropriate to the wound.” The study authors add that the mean cost to closure in the human dermis group was $1,475 per healed wound and Dr. Zelen says this is a considerable cost savings in comparison to cost to closure estimates cited for advanced grafts in other studies.

Dr. Zelen suggests considering use of the dermis graft for DFUs if wound size has not reduced by 50 percent after four weeks of standard wound care.