Apligraf, per square centimeter (Q4101)

Name of the Procedure:

Common Name: Apligraf application
Technical/Medical term: Bioengineered skin substitute application

Summary

Apligraf is a procedure that involves applying a bioengineered skin substitute, derived from living cells, to a wound or an ulcer. The product, Apligraf, is specifically designed to help wounds heal more effectively and is measured and billed per square centimeter.

Purpose

Conditions Addressed: Chronic wounds, diabetic foot ulcers, venous leg ulcers.
Goals: Promote faster and more effective wound healing by providing a biological scaffold that supports cell growth and tissue regeneration.

Indications

• Chronic non-healing wounds.
• Diabetic foot ulcers.
• Venous leg ulcers.
• Ulcers that have not responded to conventional treatment methods.

Preparation

• Clean the wound area thoroughly.
• The patient may need to stop certain medications, like blood thinners.
• A pre-procedure assessment of the wound including measuring its size.

Procedure Description

1. Wound Cleaning: The wound is cleaned and debrided (removal of dead tissue) to prepare for the application.
2. Measurement: The wound is measured to determine the amount of Apligraf needed.
3. Application: Apligraf is cut to fit the wound and then placed on the affected area.
4. Dressing: The bioengineered skin substitute is covered with a protective dressing.
   • Tools/Equipment: Scissors or a scalpel for resizing Apligraf, sterile dressing.
   • Sedation: Usually not required, may use local anesthesia if the debridement is extensive.

Duration

The procedure typically takes 30 to 60 minutes, including wound preparation and application.

Setting

The procedure is usually performed in an outpatient clinic or wound care center.

Personnel

• Primary healthcare provider or wound care specialist.
• Nurses for assistance with wound cleaning and dressing.
• Wound management specialists may also be involved.

Risks and Complications

• Common: Mild irritation or redness at the site of application.
• Rare: Infection, allergic reaction.
• Management: Monitoring, antibiotics for infection, antihistamines for allergy.

Benefits

• Accelerated wound healing.
• Reduced risk of wound infection.
• Potential for complete healing in chronic wounds.
• Benefits typically observed within weeks.

Recovery

• Keep the dressing dry and clean.
• Follow-up visits to monitor wound progress.
• Avoid strenuous activities that may impact the wound site.
• Recovery time can range from weeks to months depending on wound severity.

Alternatives

• Traditional wound care (dressing changes, topical treatments).
• Negative pressure wound therapy.
• Hyperbaric oxygen therapy.
• Pros: Traditional methods may be less expensive.
• Cons: May be less effective and slower to promote healing compared to Apligraf.

Patient Experience

• Some discomfort may be felt during wound cleaning and debridement.
• Post-application discomfort is usually minimal.
• Pain management may include over-the-counter pain relievers if necessary.
• Regular monitoring and dressing changes will be part of the post-procedure experience.