Considering that there are hundreds of wound healing interventions on the market today, it becomes vital for the wound care specialist to provide the wound what it lacks (i.e. growth factors, collagen, etc.) and decrease what it produces in excess (chronic wound fluid).  Consequently, providing the wound with what it needs at the right time is imperative.

Any bioengineered alternative tissue, particularly a living skin equivalent, MUST stay hydrated in order to achieve incorporation. Early desiccation of the wound or the BAT will result in some degree of failure. In order for the BAT to incorporate effectively into the wound to enhance healing and epithelialization, the perfect environment or “microcosm” must be present. Having the AmeriGel® Saturated Gauze Dressing in place can help achieve this ideal microcosm by providing the right amount of moisture and an antimicrobial/antifungal barrier, along with the ability to absorb exudate.

3A. A 47-year-old diabetic patient with profound peripheral neuropathy developed a blister on the plantar aspect of her right heel that became recalcitrant to conservative treatment. The patient's wound was debrided weekly and had Promogran™ applied to the site until the wound developed a healthy granular base.		3B. Apligraf® was chosen to close the wound, secured by Steri-Strips™ along with a Bledsoe® boot and wheel chair. Due to the patient's severe neuropathy, among other balance concerns, the patient could not use crutches. An saturated gauze dressing was used to cover the Apligraf®. One week post application, the absorptive capability of the saturated gauze Dressing was evident as well as its ability to maintain a moist, healthy wound base.

3C. The patient returned at two weeks and incorporation was achieved. The wound had already started to reduce in size and was considered to be a healthy granulating wound. There was no evidence of bleeding or absence of tissue caused by traumatic dressing changes.		3D. At 4 weeks and 4 days, after daily applications of the saturated gauze dressing and dry sterile gauze as the secondary dressing, the wound was healed.

Effective management of lower extremity ulcerations using a bioengineered alternative tissue with gauze dressing as the primary dressing demonstrates complete incorporation of the BAT without desiccation and wound healing. No additional BAT applications were necessary to heal this ulceration.