130 Apligraf Heals a Recalcitrant Pressure Ulcer of 28 Years Duration

Abstract

Background: Apligraf, a bioengineered living skin construct, has been shown to accelerate the healing of venous leg and diabetic foot ulcerations. It appears to function as cell-based therapy (e.g., delivering growth factors), rather than as a true graft. Given this mechanism of action, its use could be expanded to areas in which traditional skin grafting is not routinely employed. Methods: A 64-year-old wheel-chairbound Caucasian male presented to the wound clinic with a grade III left trochanteric pressure ulcer which had been present since 1976. He had been seen by numerous physicians and treated with debridement, topical antimicrobials, negative pressure therapy, growth factors, and a variety of dressings. We spent several months preparing the wound bed: maintaining adequate moisture balance, performing serial debridement, utilizing offloading surfaces and reducing the bacterial burden. His nutritional status was optimized. The wound bed developed a healthy granulating base but failed to close. Results: A single unit of Apligraf was meshed at a 1:1.5 ratio and applied to the wound. It was fixed in place using a nonstick silicone dressing, foam, and a self-adhesive covering. The dressing was changed weekly in the wound clinic. The initial response was a decrease in wound depth followed by steady epithelialization. Complete closure occurred 17 weeks after grafting. The wound has not recurred. Conclusion: This single case study suggests that bilayered cell therapy may have application in difficult wounds, such as pressure ulcerations. Further study into the efficacy of Apligraf in pressure ulcerations is ongoing.