This section of the website provides case study examples of Apligraf® appearances during wound healing*. Also included in this section are abstracts of published articles related to Apligraf and/or the treatment of venous leg ulcers†. Additional abstracts relating to Apligraf in the treatment of diabetic foot ulcers will be added in the near future.
Featured Case Study
Apligraf Case Study – Presented by Barbara Aung, DPM, CWS Tucson, AZ
52 y/o Caucasian male with an ulcer to the base of the 5th metatarsal base, left foot. The patient height is 6’8” and weight is 330lbs.
Past Medical History: Type II diabetes, Hypertension and kidney stones, HTN, history of gout, osteoarthritis of the knees, dyslipidemia and seasonal allergies.
Allergies: No known allergies
Social History: Denies smoking, denies alcohol use.
History of Present Illness: Type II diabetes, and history of foot ulcer to the right and left foot. Wound has been present at this occurrence for 4+ weeks. Swelling and mild erythema are present. Patient denies fever or chills, denies shortness of breath, denies headaches, no complaints of chest pain.
General Examination: 52 year old obese male in no acute distress. Patient showing stasis dermatitis of the pretibial region, bilateral lower limbs. The patient also has old hyperpigmented scars from folliculitis in the past. Ulcer to the lateral aspect of the plantar lateral surface of the left 5th metatarsal base, 2.5 cm in diameter, extending into the subcutaneous tissue. The drainage is from the wound is somewhat foul smelling with minimal necrotic tissue, no purulent drainage is noted. DP and PT pulses are palpable, and bounding. Arterial and venous Doppler studies were negative for arterial occlusive disease, and negative for DVT.
Treatment Plan: Unasyn is initiated. X-rays and MRI are both negative for signs of osteomyelitis. The decision is made for I&D of soft tissue and bone that is prominent at the base of the 5th metatarsal, after discussing risks and benefits, including alternatives, with patient and his wife. The deep tissue cultures showed that there is infected with Alpha Strep Viridans, colonization by Diphtheroids as well. Wound is treated with a silver dressing, and patient is placed non weight bearing in a Bledsoe boot and wheelchair. After the debridement, the cellulitis resolved within 3 days, patient was maintained on current antibiotic regimen. One week after the bone excision and soft tissue debridement Apligraf is applied (6-8-07). Dressing applied with Mepitel, saline moistened 4x4 gauze, Kerlix and Coban wrap. Dressing is next changed one week later, the contact layer, Mepitel is left is place, and all other dressings are changed with same.
4 weeks post initial application, the wound depth had filled in; reaching the surface of the surrounding skin, but the diameter of the wound had only improved by 25%, another Apligraf is applied. The second application is performed in the same fashion as described above with the same dressing regimen.
Wound size at 8 weeks is noted to be 1 cm in diameter and is 1-2 mm deep. The wound is continued to be dressed with Mepitel, saline moistened 4x4 gauze, Kerlix and Coban. Off loading continued to be achieved with Bledsoe boot and wheel chair use.
Complete wound closure noted at week 12. Patient is now in extra depth shoes with Diabetic insoles to pad and cushion the area.
*The cases presented in this section represent the experience of individual patients and may not be typical of all patients. Apligraf should not be used on infected wounds or on patients with known hypersensitivities to any components of Apligraf.
†The opinions presented in these synopses are those of the authors. These synopses may contain information about Apligraf that differs from that presented in the complete prescribing information.
Please consult the complete prescribing information for a description of epidermal and dermal elements contained in Apligraf.