The Use of Apligraf in Acute Wounds

Advances in the development of tissue engineered skin have led to several new products aimed at improving wound healing. Designed as a skin substitute, both epidermal and dermal equivalents have been under investigation and used clinically for over a decade. A novel bi‐layered living skin equivalent, Apligraf, has been approved in several countries and is approval in the US FDA for the treatment of venous ulcers. Derived from foreskin, cultured neonatal fibroblasts are combined with bovine type I collagen to form a neodermis over which cultured neonatal keratinocytes are placed, proliferate and differentiate. In addition to use in venous ulcers, Apligraf use has also been reported in acute wounds such as surgical excision sites and partial thickness donor sites. Apligraf's use in acute wounds has lent insight into its biologic behavior, safety and efficacy. Through these experiences, it has been learned that Apligraf behaves similar to a partial thickness autograft, and is safe and effective. In addition, Apligraf appears to ‘take‘, in many cases persists, is not clinically rejected but its ultimate fate is not known.