Wound Healing Products as Adjuncts to Standard Care

Jose L. Ramirez-Garcialuna, MD, PhD:

Hi, my name is Jose Ramirez-Garcialuna. I'm a medical doctor. I did my MD in Mexico. I got certified as an emergency doctor and worked for a few years in an emergency room, an ICU, and a burn unit. Afterwards I moved to Canada to do a PhD in experimental surgery and I did my PhD on the immunology of wound healing, so my area of expertise is everything that's related to immunology of wound healing, inflammation, and how this can either be of benefit or not for wound healing. Afterwards I've been working with a few companies as a scientific advisor doing research and I joined in January 2023 as Director of Medical Affairs to PolyMedics in PolyMedics Innovations. This German company that is doing some work in the US with PLA matrices, and we are launching this product in the US as of this year.

In my opinion, tending for diabetic patients requires a very holistic approach, so whenever we get a patient that has a diabetic foot ulcer we need to consider a few things. So first and foremost we need to consider whether the patient will be following the instructions given, or this will be a non-compliant patient. Whenever we have non-compliant patient, that makes very challenging cases. Also on the same lines, if the patient has a network of support, has a significant other, has children, has someone to care for the wound and help on a day-to-day basis, then that makes everything better. That makes everything easier for the healing efforts. However, if the patient does not have this kind of network, that poses a challenge.

Next, we need to check the nutritional status. We need to check whether the diabetes is in check or not, tailor the medication and whatnot, and then finally we can tend to the wound, and because we're doing these steps, some wounds will heal by themselves just by adjusting the diabetic's medication, offloading, providing some conservative care. Some wounds heal by themselves and there's no need to use advanced products. However, unfortunately, this is not the norm, and I would say most cases will require expert wound care, and in some cases this implies the use of special dressings and matrices such as the one that we use in our case. I don't want to say that one size fits all and you should use PLA matrices for every single patient, but definitely it is a very good tool to have in your armamentarium for helping these type of patients.

So one of the things that, in my opinion, it's very, very important to consider is whether this is the right product for the patient, and not only because if the patient accepts it or not. There's people who, because of religious or personal choices, will not accept an animal graft, for example, or a species like a porcine graft, for example. There's people that will say, "I won't take this," so synthetic matrices are a very good choice in that case.

There are other issues around it, so for example, there are patients who live far away from the clinic, so going every week is not feasible, so we need to think about products that can stay there for longer periods of time, two, three weeks, and have remote care for those patients, and then definitely we need to consider reimbursement.

So reimbursement is a huge part of our care strategies, and the product needs to be appealing for the patient, but also for the provider. So in this case PLA matrices have very good reimbursement rates, have reimbursement codes, so this is very attractive for providers as well for patients.