Recommendations for Using Skin Substitute Products

In this video, Jeffrey H. Hsu, MD, FACS, discusses which patients are good candidates for skin substitute products and how the products should be used in those patient populations.

This video is part 3 of a 4-part series on skin substitute products and their clinical applications. For additional content regarding skin substitute products, read the Advances article here.

Transcript

Dr. Hsu: When you’re considering using these products, you want to know as much about that patient as possible. You want to know about their medical condition. For instance, what is their nutritional status? What is their diabetic control like? Are they on medications like steroids or chemotherapy agents that might be slowing wound healing?

So, this is all information that should be known about these patients before considering the use of skin substitutes, and they need to be corrected. That may be the answer—to correct those factors so that the wound will heal.

There are a lot of factors that go into [the recommendations]. In my own practice, I deal with a lot of frail, more elderly patients who have a significant amount of vascular problems. They're called disvascular wounds. They have peripheral vascular disease. They also have a lot of problems with diabetic control and nutritional deficits.

And, at a point where we have addressed everything that we could address—we've done all the corrections, we've done the procedures, and in some cases, we've done surgery—and the wound is still not healing, I have found that biologic wound products, what we call advanced wound therapy, is able to push many of these patients to complete healing where they would have otherwise failed.

If the question is, “When would you pick one vs the other?”, there are a lot of different factors that go into that. One major factor, for me at least, is looking at the amount of defect there is in the wound. In other words, how deep is this wound? Or is it just a superficial wound vs a huge chunk of tissue looks like it was like removed?

That affects the decision because many of these products are designed for more surface wounds. And if you do have a large tissue defect, that's when I would look into more scaffolding products to fill in the space, so to speak, to allow for a certain degree of granulation, on top of which then we could put products that are better suited for putting on a surface--like a placental membrane, for instance.

So basically, what I'm saying is if there's a big wound that's deep and there's a lot of tendons and bones and things like that that's exposed, I would not go to a placental membrane right away. I would go to some sort of dermal matrix or scaffolding product in hopes of getting a layer on top of which then I could put a placental membrane on top of that.

That's how I go about my practice.